Healthcare Provider Details

I. General information

NPI: 1992807242
Provider Name (Legal Business Name): GREGORY SCOTT SMITH MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 JEFFERSON PL SUITE 1
ATHENS GA
30601-1761
US

IV. Provider business mailing address

21 JEFFERSON PL STE 1 SUITE 1
ATHENS GA
30601-1761
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-0058
  • Fax: 706-548-0555
Mailing address:
  • Phone: 706-548-0058
  • Fax: 706-548-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number047532
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number047532
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: