Healthcare Provider Details

I. General information

NPI: 1710174636
Provider Name (Legal Business Name): LARRY SHELTON KILBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHARLOIS BLVD STE 100
WINSTON SALEM NC
27103-1549
US

IV. Provider business mailing address

150 CHARLOIS BLVD STE 100
WINSTON SALEM NC
27103-1549
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-6897
  • Fax: 336-765-7306
Mailing address:
  • Phone: 336-765-6897
  • Fax: 336-765-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number15953
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: