Paul Andrew Smith, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10934 Issued in GA

Practice address

909 Eagles Landing Pkwy
Suite420
Stockbridge, GA 30281-7247

Phone

(770) 507-8010

Fax

(770) 507-4052

NPI assigned

Jan 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 16, 2015 through Dec 16, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639221708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 EAGLES LANDING PKWY",
            "address_2": "SUITE420",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817247",
            "telephone_number": "770-507-8010",
            "fax_number": "770-507-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 EAGLES LANDING PKWY",
            "address_2": "SUITE420",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817247",
            "telephone_number": "770-507-8010",
            "fax_number": "770-507-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PAUL",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "10934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Smith
• Khalil H. Smith
• Kimberly Victoria Smith, NP-C
• Kyra Smith
• Nicole L Smith, NP
• Peter E Smith, D.P.M.
• Rebecca Anne Smith, CPNP
• Skyler Andrew Smith, LPC
• Sonja Renee Smith, LPN
• Taschovia Smith, LPC, MAC, CCDP-D

• General Practice Dentistry in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.