Healthcare Provider Details

I. General information

NPI: 1750391314
Provider Name (Legal Business Name): KRISTI MARTIN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 KIRKPATRICK ROAD SUITE 200
BURLINGTON NC
27215-8066
US

IV. Provider business mailing address

267 S CHURTON ST STE 100
HILLSBOROUGH NC
27278-2696
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-3100
  • Fax: 336-584-0696
Mailing address:
  • Phone: 336-584-3100
  • Fax: 336-584-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200500703
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: