Healthcare Provider Details

I. General information

NPI: 1255855060
Provider Name (Legal Business Name): RACHAEL CHRISTINA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 7TH STREET UNIT A
CHARLOTTE NC
28263-5812
US

IV. Provider business mailing address

PO BOX 63376
CHARLOTTE NC
28263-5812
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7900
  • Fax: 704-376-2216
Mailing address:
  • Phone: 704-372-7900
  • Fax: 704-376-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberFS3160188
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberFS2618722
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: