Leslie Deanna Smoak, MD – Pediatrics Physician

Key facts

NPI: 1619170602
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 64277 (GA)
Practice address: 735 Glynn Street South
Fayetteville, GA 30214
Phone: (770) 461-4126
NPI assigned: Jun 7, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Abc Pediatrics Pediatrics Physician · Fayetteville, GA · NPI 1902923964

NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
64277	GA	MD	Pediatrics Physician

Practice roles

Organization	Specialty	Status	New patients
Abc Pediatrics	Pediatrics	Past since Aug 4, 2024	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Pediatrics Physician	208000000X	64277	GA	Yes

Addresses

Primary practice location

735 Glynn Street South
Fayetteville, GA 30214

Mailing address

735 Glynn Street South
Fayetteville, GA 30214
Phone (770) 461-4126

Other providers in Fayetteville, GA

All providers in Fayetteville, GA · Pediatrics Physician in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.