Samuel L Jewett III, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002656 Issued in GA

Practice address

6000 Joe Frank Harris Pkwy NW
Suite D
Adairsville, GA 30103-2443

Phone

(770) 773-9201

Fax

(770) 773-3080

NPI assigned

May 22, 2006

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Calhoun Medical Group LLC

  • Family Medicine Physician
  • Calhoun, GA
  • NPI 1972881423
  NPD (past)
• Gordon Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Calhoun, GA
  • NPI 1205290467
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760436752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 KNIGHT BOTTOM RD SE",
            "city": "FAIRMOUNT",
            "state": "GA",
            "postal_code": "301392053",
            "telephone_number": "770-608-9379",
            "fax_number": "770-773-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 JOE FRANK HARRIS PKWY NW",
            "address_2": "SUITE D",
            "city": "ADAIRSVILLE",
            "state": "GA",
            "postal_code": "301032443",
            "telephone_number": "770-773-9201",
            "fax_number": "770-773-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEWETT",
        "first_name": "SAMUEL",
        "middle_name": "L",
        "name_suffix": "III",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Highland Rivers Community Service Board
• Highland Rivers Community Service Board
• Highland Rivers Community Service Board
• Amy Elizabeth Howell, PMHNP
• Elisa Jaramillo-Mayor, M.D., M.P.H.
• Emily King Johnson, FNP
• Andrea Harner Kovacic, MD
• Michael Tyler Land, MD
• David Lane, DMD
• Kandi Lewis

• All providers in Adairsville, GA
• Physician Assistant 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.