Organization
GOCO SURGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI G KELLAM MD (OWNER)
(336) 659-9440
Entity
Organization
Contact information
Practice address
760 HIGHLAND OAKS DR, SUITE 200, WINSTON SALEM, NC 27103-7105
(336) 768-4710
(336) 659-9845
Mailing address
760 HIGHLAND OAKS DR, SUITE 200, WINSTON SALEM, NC 27103-7105
(336) 768-4710
(336) 659-9845
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9600966
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0191H
BCBS OF NC
NC
05
—
890191H
—
NC
Enumeration date
01/15/2007
Last updated
04/13/2012
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