Provider Demographics
NPI:1326134826
Name:SMITH, JAMES C (NP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-4818
Mailing Address - Country:US
Mailing Address - Phone:478-300-7107
Mailing Address - Fax:478-783-3961
Practice Address - Street 1:259 BROAD ST
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-4818
Practice Address - Country:US
Practice Address - Phone:478-300-7107
Practice Address - Fax:478-783-3961
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA957685038DMedicaid
GA957685038CMedicaid
GA957685038GMedicaid
P00428791OtherRAILROAD MEDICARE
GA957685038FMedicaid
GA957685038BMedicaid
GA957685038AMedicaid
GA50BBKTGMedicare PIN
GA957685038GMedicaid
GA957685038DMedicaid
GA957685038CMedicaid
GA50BBLGZMedicare PIN