Provider Demographics
NPI:1144290917
Name:SMITH, RODNEY LEWIS (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-534-1986
Practice Address - Fax:770-297-5645
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018553207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000270498CMedicaid
GA52158651OtherBCBS
GA010036487OtherRR MEDICARE
GA10045346OtherAMERIGROUP
GA336487OtherWELLCARE
GA9733397OtherCIGNA
GA000679764AMedicaid
GA0100310OtherUNITED HEALTHCARE
GA01BDGTVMedicare ID - Type Unspecified
GA010036487OtherRR MEDICARE
GA336487OtherWELLCARE