=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750391314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTI MARTIN SMITH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 08/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1041 KIRKPATRICK ROAD SUITE 200
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-584-3100
-----------------------------------------------------
Fax | 336-584-0696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 267 S CHURTON ST STE 100
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27278-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-584-3100
-----------------------------------------------------
Fax | 336-584-0696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 200500703
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------