Provider Demographics
NPI:1023649001
Name:SMITH, AKEMI
Entity type:Individual
Prefix:
First Name:AKEMI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720944
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-0944
Mailing Address - Country:US
Mailing Address - Phone:601-624-3619
Mailing Address - Fax:
Practice Address - Street 1:604 HIGHWAY 80 W STE K3
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4108
Practice Address - Country:US
Practice Address - Phone:769-257-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2021-09-30
Deactivation Date:2020-07-20
Deactivation Code:
Reactivation Date:2020-09-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist