MEDICARE: MEDPSYCH INNOVATIONS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1912860818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPSYCH INNOVATIONS PLLC

Provider Business Mailing Address
First Line	:	7826 SPUNGOLD ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8603
Country	:	US
Telephone Number	:	919-561-9391
Fax Number	:	919-561-9391

Provider Business Practice Location Address
First Line	:	7826 SPUNGOLD ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8603
Country	:	US
Telephone Number	:	919-561-9391
Fax Number	:	919-561-9391

Authorized Official
Title or Position	:	PSYCHIATRIC PA-C/PRESIDENT
Name	:	KAMI SMITH HARRIS
Credential	:	PA-C
Telephone Number	:	919-561-9391

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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