Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2012-01171 | NC |
Y | 207VX0201X | Gynecologic Oncologist | 2012-01171 | NC |
NPI | 1477541399 |
---|---|
Provider Name | Michael Greg Kelly |
First Address | Charlotte, NC 28260-2658 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 17/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1477541399 | (05) | VA |
3810023441 | (05) | WV |
5921109 | (05) | NC |
Q0117T | (05) | SC |