DR. JEFFERY LEROY BOUADOU (M.D.) – Hospitalist Physician, NPI 1114218633

DR. JEFFERY LEROY BOUADOU (M.D.) is a healthcare provider. based in Winder, Georgia. specializing in FAMILY PRACTICE. They hold the professional credentials M.D.. They hold a License No. 071932 (GA). The NPI Number for DR. JEFFERY LEROY BOUADOU (M.D.) is 1114218633

Main info

Male
16 Years Of Experience
Accepts Medicare Assignment
Name
DR. JEFFERY LEROY BOUADOU (M.D.)
NPI
1114218633
Phone
(770) 867-3400
Address
316 N BROAD ST
Enumeration Date
2 May 2011
Last Update Date
7 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7705145405
Graduation Year
2010 (16 years ago)
PAC ID
2961628052
Group Practice PAC ID
6204829013
Professional Enrollment ID
I20140725001468
Address ID
GA301445579KE750XXNWXX400

Contacts

SOAP Endpoint
https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience49
Completeness85
Years active:15State licenses:1Other namesUpdated within 12 months

3,102 FAMILY PRACTICE in GA

Provider Addresses for DR. JEFFERY LEROY BOUADOU (M.D.)

  • 316 N BROAD ST

    WINDER, GA 306802150

    Phone: (770) 867-3400

    Type: Mailing

  • 1200 MEMORIAL DR

    DALTON, GA 307202529

    Phone: (706) 217-2207

    Type: Location

  • 316 N Broad St

    Winder, GA 306802150

    Phone: (770) 867-3400

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2014-07-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20140725001468IFamily PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30680)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6204829013View full group profile

Reviews

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Frequently asked questions

Does DR. JEFFERY LEROY BOUADOU (M.D.) have a public NPI I can cite?
Public records show DR. JEFFERY LEROY BOUADOU (M.D.) under NPI 1114218633.
Is DR. JEFFERY LEROY BOUADOU (M.D.) currently accepting referrals based on NPI status?
Registry metadata lists DR. JEFFERY LEROY BOUADOU (M.D.) as active.
What does the directory say DR. JEFFERY LEROY BOUADOU (M.D.) does?
Insurance directories may phrase it differently, but here DR. JEFFERY LEROY BOUADOU (M.D.) maps to Hospitalist Physician. Clinical services aligned with this taxonomy classification.
Is DR. JEFFERY LEROY BOUADOU (M.D.) tied to Winder, Georgia?
If you are local to Winder, Georgia, DR. JEFFERY LEROY BOUADOU (M.D.) may be relevant to your search.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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