Provider Demographics
NPI:1467442327
Name:SMITH, JAMES LEON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1270 PRINCE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2762
Mailing Address - Country:US
Mailing Address - Phone:706-548-1388
Mailing Address - Fax:706-354-1818
Practice Address - Street 1:1270 PRINCE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2762
Practice Address - Country:US
Practice Address - Phone:706-548-1388
Practice Address - Fax:706-354-1818
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA13774207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00088052AMedicaid
GAD42105Medicare UPIN