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1457323909

NPI Code Detail

MEDICARE: KENNETH L SMITH MD

MEDICARE: KENNETH L SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	048722	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	20046782	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	52262489-003	OTHER	GA	BCBS
7	52262489-005	OTHER	GA	BCBS
8	600-11156	OTHER	AL	BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	600-96706	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1457323909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH L SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 1038
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-1038
Country	:	US
Telephone Number	:	706-660-6148
Fax Number	:	706-660-2843

Provider Business Practice Location Address
First Line	:	1831 5TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8915
Country	:	US
Telephone Number	:	706-320-8660
Fax Number	:	706-320-8664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	01/20/2014

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Directions to “ KENNETH L SMITH MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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