Holly Gwen Smith, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2005-00116 Issued in NC

Practice address

6488 Weddington-Monroe Rd
Wesley Chapel, NC 28104-6277

Phone

(704) 384-8460

Fax

(704) 384-1018

NPI assigned

Nov 21, 2006

Last updated

Oct 25, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Child & Adolescent Medical Group

  • Pediatrics Physician
  • Wesley Chapel, NC
  • NPI 1518448679
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1689749418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6115 PARK SOUTH DR",
            "address_2": "SUITE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103269",
            "telephone_number": "704-944-8388",
            "fax_number": "704-944-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6488 WEDDINGTON-MONROE RD",
            "city": "WESLEY CHAPEL",
            "state": "NC",
            "postal_code": "281046277",
            "telephone_number": "704-384-8460",
            "fax_number": "704-384-1018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6115 Park South Dr",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282103269",
            "country_code": "US",
            "telephone_number": "704-944-8388",
            "fax_number": "704-944-8389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "HOLLY",
        "middle_name": "GWEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2005-00116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hsmith126465@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "6115 Park South Dr",
            "address_2": "Suite 105",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282103269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Faran Pittman, MD
• Publix North Carolina LP (Publix Pharmacy #2120)
• Ricahrd E. Graham DMD PLLC
• Charissa Joy Richard, DO
• Matthew Jon Richter, D.O.
• Kristen Marie Smith, CNM
• Ryan Jason Stempniak, MD
• Union Physicians Network Inc (Wesley Chapel Family Medicine)
• Katherine Sloan Ware, PHARMD
• Marie Elizabeth Watson, CNM

• Pediatrics Physician in Wesley Chapel, NC
• Providers in Wesley Chapel, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.