| Doctor Name: | MR. JEREMY K SMALLWOOD |
| NPI Number: | 1124253521 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPA/RA, RT(R)(VI) |
| License Number: | |
| Business Practice Address: | 3109 Bienville Blvd Ocean Springs, MS - 395644361 |
| Business Phone Number: | 2288181117 |
| Business Fax Number: | 2288186090 |
| Mailing Address: | 3109 Bienville Blvd, OCEAN SPRINGS |
| State: | MS |
| Postal Code: | 395644361 |
| Phone Number: | 2288181117 |
| Fax Number: | 2288186090 |
| NPI Enumeration Date: | 05/28/2009 |
| NPI Last Update Date: | 05/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471V0106X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Vascular-Interventional Technology |
| Taxonomy Definition: | |