Amielle Lydia Smith, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

00000 Issued in GA

Practice address

4106 Columbia Rd Ste 103
Martinez, GA 30907-1482

Phone

(706) 863-1440

Fax

(706) 863-5418

NPI assigned

Sep 29, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amielle Lydia Burch Former name

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://fhir-myrecord.cerner.com/r4/d88010de-d791-42d4-b72d-513f9afc5ed1/

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.

• Aga Professional Services, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1063799120
  NPD (past)
• Covenant Multispecialty Group

  • Pediatrics Physician
  • Martinez, GA
  • NPI 1942376918
  NPD (past)

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1861009375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 COLUMBIA RD STE 103",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309071482",
            "telephone_number": "706-863-1440",
            "fax_number": "706-863-5418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 COLUMBIA RD STE 103",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309071482",
            "telephone_number": "706-863-1440",
            "fax_number": "706-863-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMIELLE",
        "middle_name": "LYDIA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "00000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMIELLE",
            "last_name": "BURCH",
            "middle_name": "LYDIA",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Marie Sigg, RBT
• Destiny Simmons
• Rosina Skaria, MSW
• Ajeea Smalley
• Smith & Bones Physical Therapy LLC
• Jennifer Claudia Smith
• Jerry Smith, LCSW
• Natalie Brooke Smith, C.C.C.-S.L.P.
• Nicchoe N Smith
• Sydney Smith

• Physician Assistant in Martinez, GA
• Providers in Martinez, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; 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.