Cynthia M Smith, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

7814 Issued in GA

Practice address

1275 Highway 54 W Ste 201
Fayetteville, GA 30214-4538

Phone

(770) 461-3776

Fax

(770) 461-3565

NPI assigned

Mar 25, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Cynthia M Theobald Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1033179700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 COBB PKWY NW STE 324-201",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301018320",
            "telephone_number": "915-474-7675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W STE 201",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144538",
            "telephone_number": "770-461-3776",
            "fax_number": "770-461-3565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42d Medical Group",
            "address_2": "300 Twining St., Bldg 760",
            "address_purpose": "LOCATION",
            "city": "Maxwell AFB",
            "state": "AL",
            "postal_code": "36112",
            "country_code": "US",
            "telephone_number": "334-953-3368",
            "fax_number": "334-953-8607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CYNTHIA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-25",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-002328",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "7814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cynthia.m.theobald.ctr@mail.mil",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "42d Medical Group",
            "address_2": "300 Twining St., Bldg 760",
            "city": "Maxwell AFB",
            "state": "AL",
            "country_code": "US",
            "postal_code": "36112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "THEOBALD",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Smile Mission Fayetteville LLC
• Marilynn Rae Smith-Bowles, NP
• Alexis Smith, RBT, BS
• Barbara Ann Smith, DPT
• Connor Mitchell Smith, MD
• Erin Dee Smith
• Evon Smith
• Harvelyn Duncan Smith, P.T.
• Ida Smith, NP
• Jennifer Smith

• Medical Physician Assistant in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.