Provider Demographics
NPI:1518245950
Name:SMITH, HOLLY KRISTIN (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KRISTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 GARDEN STATE LN
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 LAUREL ST STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2025
Practice Address - Country:US
Practice Address - Phone:803-252-1953
Practice Address - Fax:803-217-6750
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019412207R00000X
SC39378207R00000X, 207RN0300X
FLOS18134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393782Medicaid