Provider Demographics
NPI:1972923001
Name:SMITH, JOHN PATRICK (CP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4007
Mailing Address - Country:US
Mailing Address - Phone:662-842-3220
Mailing Address - Fax:662-842-3221
Practice Address - Street 1:223 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4007
Practice Address - Country:US
Practice Address - Phone:662-842-3220
Practice Address - Fax:662-842-3221
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management