Healthcare Provider Details

I. General information

NPI: 1407804420
Provider Name (Legal Business Name): HOLLY LYNN SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SOUTH MAIN ST.
RURAL RETREAT VA
24368
US

IV. Provider business mailing address

PO BOX 753
RURAL RETREAT VA
24368-0753
US

V. Phone/Fax

Practice location:
  • Phone: 276-686-5116
  • Fax: 276-686-6289
Mailing address:
  • Phone: 276-686-5116
  • Fax: 276-686-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101047615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: