Basic Information
| Provider Information | |||||||||
| NPI: | 1467642801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 CLINTON CENTER DR STE 4300 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390565610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014969794 | ||||||||
| FaxNumber: | 6018150434 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018152005 | ||||||||
| FaxNumber: | 6018150434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 095545 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 44722 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RT0003X | 44722 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | 207RI0008X | 44722 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207R00000X | 27080 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201307280 | 05 | IN | MEDICAID | 7100358150 | 05 | KY | MEDICAID |