Healthcare Provider Details

I. General information

NPI: 1063918670
Provider Name (Legal Business Name): CMS MED HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3878 OXFORD STATION WAY
WINSTON SALEM NC
27103-1340
US

IV. Provider business mailing address

3878 OXFORD STATION WAY
WINSTON SALEM NC
27103-1340
US

V. Phone/Fax

Practice location:
  • Phone: 336-309-5900
  • Fax: 336-283-0874
Mailing address:
  • Phone: 336-309-5900
  • Fax: 336-283-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS J KELLY
Title or Position: REGISTERED AGENT
Credential:
Phone: 336-749-5194