Active NPI
Jillian Smith
- Surgery Physician
- Jackson, MS
National Provider Identifier
1700375847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 27890
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-1000
- NPI assigned
- May 3, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Surgery Physician | 208600000X | 27890 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
72 Lewallen Dr
Purvis, MS 39475-3652
Phone (769) 223-3232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27890 | MS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602547200000",
"number": "1700375847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 LEWALLEN DR",
"city": "PURVIS",
"state": "MS",
"postal_code": "394753652",
"telephone_number": "769-223-3232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JILLIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-03",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MS",
"license": "27890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.