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General NPI Number Information
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NPI Number | 1730170374
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Entity Type | Individual
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Provider Name | WILLIAM SHERWOOD KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 420 W MOUNTAIN ST
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City | KERNERSVILLE
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State | NC
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Zip | 27284-2534
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Country | US
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Telephone | 336-993-1618
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Fax |
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Provider Business Mailing Address
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Address Line | 420 W MOUNTAIN ST
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City | KERNERSVILLE
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State | NC
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Zip | 27284-2534
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Country | US
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Telephone | 336-993-1618
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Fax | 336-993-5512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 26282
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26282
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License Number State | NC
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