Healthcare Provider Details

I. General information

NPI: 1255628517
Provider Name (Legal Business Name): SOMJADE JAY SONGCHAROEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 315
JACKSON MS
39216-4607
US

IV. Provider business mailing address

971 LAKELAND DR STE 315
JACKSON MS
39216-4607
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-9530
  • Fax: 601-206-0153
Mailing address:
  • Phone: 601-414-9530
  • Fax: 601-206-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number23081
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number23081
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number23081
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: