Individual
DR. KELLIE A FAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 WESTGATE CENTER DRIVE, SUITE 130, WINSTON SALEM, NC 27103-3104
(336) 659-8703
(336) 659-8704
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 659-8703
(336) 659-8704
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
9601607
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891003P
—
NC
Enumeration date
08/19/2005
Last updated
12/08/2016
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