Individual
KENNETH L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1831 5TH AVE, COLUMBUS, GA 31904-8915
(706) 320-8660
(706) 320-8664
Mailing address
PO BOX 1038, COLUMBUS, GA 31902-1038
(706) 660-6148
(706) 660-2843
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
048722
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000879029A
—
GA
01
—
000879029B
MEDICAID-OFFICE
GA
01
—
000879029C
MEDICAID-DSH
GA
01
—
000879029D
MEDICAID-MMC
GA
01
—
000879029E
MEDICAID-NSMC
GA
05
—
009931860
—
AL
01
—
154859
MEDICAID-MMC
AL
01
—
20046782
RAILROAD MEDICARE
GA
01
—
52262489-003
BCBS
GA
01
—
52262489-005
BCBS
GA
01
—
600-11156
BCBS
AL
01
—
600-96706
BCBS
AL
Enumeration date
02/07/2006
Last updated
01/20/2014
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