Percy L Smith Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA058 Issued in MS

Practice address

1883 Hwy 43 South, Suite D
Canton, MS 39046

Phone

(601) 859-8992

Fax

(601) 859-7642

NPI assigned

Oct 2, 2006

Last updated

Aug 2, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mr. Percy L Smith Jr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cantons Physician Group

  • Nurse Practitioner
  • Canton, MS
  • NPI 1619088838
  NPD (past)
• Central Jackson Family Medical Clinic

  • Medical Specialty Clinic/Center
  • Jackson, MS
  • NPI 1154549707
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312243200000",
    "number": "1003909854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1883 HWY 43 SOUTH, SUITE D",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-859-8992",
            "fax_number": "601-859-7642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1883 HWY 43 SOUTH, SUITE D",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-859-8992",
            "fax_number": "601-859-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PERCY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05475760",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PERCY",
            "last_name": "SMITH",
            "middle_name": "L",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Smilebuilders Inc
• Smith Evans (Christian Home Health of Madison)
• Carla G. Smith, R.PH.
• Maria L Smith, PMHNP-BC, C-FNP, LPC
• Mary Melvin Smith, NP
• Rachel Nicole Smith
• Latoya Sojourney, FNP
• Judith Stallings, NP
• Shadekra Stasher
• State of Mississippi - University of Mississippi Medical Center (Merit Health Madison)

• Physician Assistant in Canton, MS
• Providers in Canton, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.