Healthcare Provider Details

I. General information

NPI: 1982811097
Provider Name (Legal Business Name): MISSISSIPPI PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAYFAIR DR STE 400
JACKSON MS
39232-9717
US

IV. Provider business mailing address

1 LAYFAIR DR STE 400
JACKSON MS
39232-9717
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-0238
  • Fax: 601-932-4391
Mailing address:
  • Phone: 601-932-0238
  • Fax: 601-932-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY T SUMMERS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 601-932-0238