Provider Demographics
NPI:1356479828
Name:SMITH, AILISA HIPP (MD)
Entity Type:Individual
Prefix:
First Name:AILISA
Middle Name:HIPP
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TATE BLVD SE
Mailing Address - Street 2:SUITE 186
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-324-0359
Mailing Address - Fax:828-324-0358
Practice Address - Street 1:915 TATE BLVD SE
Practice Address - Street 2:SUITE 186
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-324-0359
Practice Address - Fax:828-324-0358
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00610207Q00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022135OtherMEDICARE
NC5909242Medicaid
NCCN8132OtherRAILROAD MEDICARE
NCFK887832OtherDEA