Amanda S Smith, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103832 Issued in FL

Practice address

700 Riverside Ave
Waycross, GA 31501-5358

Phone

(912) 490-8546

Fax

(877) 221-0052

NPI assigned

Sep 16, 2006

Last updated

Dec 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Braco Medical Services LLC

  dba Vitality Health and Wellness

  • Physician Assistant
  • Waycross, GA
  • NPI 1124823570
  NPD Authorized official
• Southeast Georgia Primary Care

  • Family Medicine Physician
  • Waycross, GA
  • NPI 1053429688
  NPD
• Douglas Family Medicine Assoc

  • Family Medicine Physician
  • Douglas, GA
  • NPI 1508915687
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1316043227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015358",
            "telephone_number": "912-490-8546",
            "fax_number": "877-221-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015358",
            "telephone_number": "912-490-8546",
            "fax_number": "877-221-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003130352C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292817500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shuman Healthcare Specialty Pharmacy Inc.
• Heather Marie Simmons, M.ED., CCC-SLP
• Pushpa Singh, NP-C
• Sistar Eyecare Associates
• Catherine Skinner
• Brenda Martin Smith
• James Matthew Smith Jr., DMD
• Keri Smith, MED, CCC-SLP
• Laura Smith, LMSW
• Sabrina Music Smith, CCC-SLP

• Medical Physician Assistant in Waycross, GA
• Providers in Waycross, 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 Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.