1922054998 NPI number — HUGH FRANKLIN SMISSON III

Table of content: HUGH FRANKLIN SMISSON III (NPI 1922054998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922054998 NPI number — HUGH FRANKLIN SMISSON III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMISSON
Provider First Name:
HUGH
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMISSON
Provider Other First Name:
HUGH
Provider Other Middle Name:
FRANKLIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922054998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 PINE ST STE 880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-7525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-743-7092
Provider Business Mailing Address Fax Number:
478-743-6293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 880
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-743-7092
Provider Business Practice Location Address Fax Number:
478-743-6293
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  035524 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 035524 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00495338A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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