Healthcare Provider Details

I. General information

NPI: 1750250577
Provider Name (Legal Business Name): SOUTHERN INTERVENTIONAL PAIN SPECIALISTS JACKSON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
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 TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY SMITHERMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 601-891-5524