NPIMap

Individual provider Active NPI

George Leon Smith III, MD

  • Family Medicine Physician
  • Covington, GA
National Provider Identifier
1750426920
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
021816 Issued in GA
Practice address
4166 A Newton Drive
Covington, GA 30014
Phone
(770) 786-0643
Fax
(770) 787-0248
NPI assigned
Feb 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 021816 GA Primary

Addresses

Primary practice location

4166 A Newton Drive
Covington, GA 30014

Mailing address

PO Box 1557
Covington, GA 30015-1557
Phone (770) 786-0643

Other identifiers 1

IdentifierTypeStateIssuer
00247706BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110519000184 GA Practitioner - Family Practice 3173709532 Practice locations: Covington, GA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Georgia School of Medicine, 1979
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4166 A Newton Dr
Covington, GA 30014-2522

4166 Newton Dr
Covington, GA 30015-1557
Phone (770) 786-0643

PO Box
Suite 1557
Covington, GA 30015-1557

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Guiding Light Hospice SW, LLCNewnan, GA, CCN 851610 Hospice Contracted Managing Employee Jul 10, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260316800000",
    "number": "1750426920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1557",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300151557",
            "telephone_number": "770-786-0643",
            "fax_number": "770-787-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4166 A NEWTON DRIVE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "30014",
            "telephone_number": "770-786-0643",
            "fax_number": "770-787-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GEORGE",
        "middle_name": "LEON",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2009-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "021816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00247706B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

Verify at the official NPI Registry.