Individual
MICHAEL GREG KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-6673
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2012-01171
NC
207VX0201X
Gynecologic Oncology Physician
Primary
2012-01171
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477541399
—
VA
05
—
3810023441
—
WV
05
—
5921109
—
NC
05
—
Q0117T
—
SC
Enumeration date
10/13/2005
Last updated
06/17/2014
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