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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | ANDREW WAYNE KELLY | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1992888242 | [sources] | |||
| Status | not available | [sources] | |||
| Address | WINSTON SALEM, NC 27104 | [sources] | |||
| Last change | Last processed | First seen | |||
Service providers who have been terminated for cause from North Carolina's Medicaid and other Health Programs.
United States · NC Medicaid Division of Health Benefits
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