Healthcare Provider Details

I. General information

NPI: 1457507055
Provider Name (Legal Business Name): JEREMY D SMITHERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR STE 301A
MADISON MS
39110-2012
US

IV. Provider business mailing address

133 CALUMET DR
MADISON MS
39110-9298
US

V. Phone/Fax

Practice location:
  • Phone: 601-891-5524
  • Fax:
Mailing address:
  • Phone: 601-720-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT2111
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number21996
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: