Provider Demographics
NPI:1558514752
Name:HOLLY SPRINGS PEDIATRICS
Entity Type:Organization
Organization Name:HOLLY SPRINGS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SWARTZ-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-249-4700
Mailing Address - Street 1:106 HYANNIS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8327
Mailing Address - Country:US
Mailing Address - Phone:919-249-4700
Mailing Address - Fax:919-249-4701
Practice Address - Street 1:106 HYANNIS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8327
Practice Address - Country:US
Practice Address - Phone:919-249-4700
Practice Address - Fax:919-249-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty