Provider Demographics
NPI:1114934643
Name:SMITHERMAN, JAMES ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ADAM
Last Name:SMITHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30594
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0594
Mailing Address - Country:US
Mailing Address - Phone:601-987-8200
Mailing Address - Fax:601-987-8211
Practice Address - Street 1:104 BURNEY DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6621
Practice Address - Country:US
Practice Address - Phone:601-987-8200
Practice Address - Fax:601-987-8211
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24715207X00000X
FLME107021207X00000X
ARE-7027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07275376Medicaid
AR188367001Medicaid