NPIMap

Organization Active NPI

Renuven Health Partners of Georgia PC

  • Internal Medicine Physician
  • Fort Oglethorpe, GA
National Provider Identifier
1871196519
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RENUVEN HEALTH PARTNERS OF GEORGIA PC
Practice address
2403 Battlefield Pkwy
Fort Oglethorpe, GA 30742-4033
Phone
(423) 979-5804
NPI assigned
Nov 17, 2020
Last updated
Sep 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Authorized official

Name
Bert J. Smith, MDNPI 1497839070
Title
Ceo
Phone
(423) 926-2358

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

2403 Battlefield Pkwy
Fort Oglethorpe, GA 30742-4033

Mailing address

2717 E Oakland Ave
Johnson City, TN 37601-1843
Phone (423) 926-2358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201210000229 GA Part B Supplier - Clinic/Group Practice 5890107171 Receives reassigned benefits from 12 practitioners
Practice locations: Ft Oglethorpe, GA

National Provider Directory

National Provider Directory

Locations

208 Sunset Dr
Ste 210
Johnson City, TN 37604
Phone (423) 979-5804

Practitioners & affiliated clinicians

Practitioners 100

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1871196519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 E OAKLAND AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011843",
            "telephone_number": "423-926-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 BATTLEFIELD PKWY",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424033",
            "telephone_number": "423-979-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENUVEN HEALTH PARTNERS OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BERT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-926-2358",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Oglethorpe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.