Active NPI
Jerry Smith
- Assisted Living Facility
- Dawsonville, GA
National Provider Identifier
1538572730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- PCH005362
- Practice address
- 50 Tanglewood Dr
Dawsonville, GA 30534-8140 - Phone
- (706) 867-0106
- Fax
- (706) 864-3368
- NPI assigned
- Jun 4, 2014
- Last updated
- Jun 4, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | PCH005362 | GA | Primary |
Addresses
Primary practice location
50 Tanglewood Dr
Dawsonville, GA 30534-8140
Mailing address
50 Tanglewood Dr
Dawsonville, GA 30534-8140
Phone (706) 867-0106
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCH005362 | GA | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401840000000",
"number": "1538572730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 TANGLEWOOD DR",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305348140",
"telephone_number": "706-867-0106",
"fax_number": "706-864-3368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 TANGLEWOOD DR",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305348140",
"telephone_number": "706-867-0106",
"fax_number": "706-864-3368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JERRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-04",
"last_updated": "2014-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "GA",
"license": "PCH005362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dawsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.