Kaitlyn Smith, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9190 Issued in GA

Practice address

343 Salem Gate Dr SE Ste 100
Conyers, GA 30013-1783

Phone

(770) 285-3533

Fax

(770) 502-6052

NPI assigned

Mar 11, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Emory University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Georgia, LLCGroup PAC ID 9638485782, 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

94.02 of 100Reported as group

Quality

88.03

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Advanced Dermatology of Georgia, LLC

  • Dermatology Physician
  • Albany, GA
  • NPI 1184005068
  Medicare reassignment Care Compare group
• Super Dermatology LLC

  • Dermatology Physician
  • Conyers, GA
  • NPI 1669971776
  NPD
• North Georgia Dermatology, P.C.

  • Dermatology Physician
  • Lawrenceville, GA
  • NPI 1154483139
  NPD (past)

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1245798032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 SALEM GATE DR SE STE 100",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131783",
            "telephone_number": "770-285-3533",
            "fax_number": "770-502-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 SALEM GATE DR SE STE 100",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131783",
            "telephone_number": "770-285-3533",
            "fax_number": "770-502-6052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 GA-34",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "30265",
            "country_code": "US",
            "telephone_number": "770-502-2121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1364 Wellbrook Cir NE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300123872",
            "country_code": "US",
            "telephone_number": "770-285-3533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KAITLYN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-11",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "GA",
            "license": "9190",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "9190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danyelle M Smith, FNP
• Ethel L Smith, MD
• Eulanda S Smith
• Harmon Andrew Smith, M.D.
• Joli A Smith, PA-C
• Kanisha Smith
• Khaliliah Kendra Smith
• Letrece Smith
• Marcia Wootson Smith, LPC
• Shawndria Nicole Smith, LCSW

• Medical Physician Assistant in Conyers, GA
• Providers in Conyers, 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 Jul 28, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.