Individual provider Active NPI

Holly Christine Smith, RN, CPNP

  • Pediatric Nurse Practitioner
  • Marietta, GA
National Provider Identifier
1962883090
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN234034 Issued in GA
Practice address
175 White St NW Ste 200
Marietta, GA 30060-7901
Phone
(770) 487-3330
Fax
(770) 487-7736
NPI assigned
Jun 15, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN234034 GA Primary

Addresses

Primary practice location

175 White St NW Ste 200
Marietta, GA 30060-7901

Mailing address

175 White St NW Ste 200
Marietta, GA 30060-7901
Phone (770) 487-3330

Other practice location 1

12 Eastbrook Bnd
Peachtree City, GA 30269-1530
Phone (770) 487-3330

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hsmith296702@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Certified Pediatric Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN234034GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Pediatrics PC Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1962883090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 WHITE ST NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607901",
            "telephone_number": "770-487-3330",
            "fax_number": "770-487-7736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 WHITE ST NW STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607901",
            "telephone_number": "770-487-3330",
            "fax_number": "770-487-7736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Eastbrook Bnd",
            "address_purpose": "LOCATION",
            "city": "Peachtree City",
            "state": "GA",
            "postal_code": "302691530",
            "country_code": "US",
            "telephone_number": "770-487-3330",
            "fax_number": "770-487-7736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "HOLLY",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "RN, CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-15",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN234034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hsmith296702@directwellstar.org",
            "affiliation": "N",
            "address_1": "175 White St NW Ste 200",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300607901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.