Healthcare Provider Details

I. General information

NPI: 1912860818
Provider Name (Legal Business Name): MEDPSYCH INNOVATIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 SPUNGOLD ST
RALEIGH NC
27617-8603
US

IV. Provider business mailing address

7826 SPUNGOLD ST
RALEIGH NC
27617-8603
US

V. Phone/Fax

Practice location:
  • Phone: 919-561-9391
  • Fax: 919-561-9391
Mailing address:
  • Phone: 919-561-9391
  • Fax: 919-561-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMI SMITH HARRIS
Title or Position: PSYCHIATRIC PA-C/PRESIDENT
Credential: PA-C
Phone: 919-561-9391