Healthcare Provider Details

I. General information

NPI: 1336797331
Provider Name (Legal Business Name): KELLY ELIZABETH FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STALLINGS-EVANS SPORTS MEDICINE CENTER 91 STADIUM DRIVE
CHAPEL HILL NC
27215
US

IV. Provider business mailing address

STALLINGS-EVANS SPORTS MEDICINE CENTER 91 STADIUM DRIVE
CHAPEL HILL NC
27215
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-2281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberLAT-4010
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: