Individual
MARK HUMPHREYS KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 MEDICAL CENTER DR, WILMINGTON, NC 28401-7354
(910) 762-3882
Mailing address
PO BOX 63233, CHARLOTTE, NC 28263-3233
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2023-01135
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2018
Last updated
09/03/2024
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