Healthcare Provider Details

I. General information

NPI: 1356479828
Provider Name (Legal Business Name): AILISA HIPP SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 16TH ST NE
HICKORY NC
28601-9600
US

IV. Provider business mailing address

2810 16TH ST NE
HICKORY NC
28601-9600
US

V. Phone/Fax

Practice location:
  • Phone: 828-324-0359
  • Fax: 828-324-0358
Mailing address:
  • Phone: 828-324-0359
  • Fax: 828-324-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number2008-00610
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008-00610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: