MEDICARE: DR. HOLLY LAIN HUMPHREY M.D.

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	207R00000X	Internal Medicine Physician	2008-00471	NC
2	207RC0000X	Cardiovascular Disease Physician	2008-00471	NC
3	207RI0011X	Interventional Cardiology Physician	2008-00471	NC

General Provider Information

NPI Number	:	1952526980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY LAIN HUMPHREY M.D.

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-6674
Fax Number	:	336-716-9188

Provider Business Practice Location Address
First Line	:	1695 KERNERSVILLE MEDICAL PKWY
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7159
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:	336-515-5310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	09/12/2025

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