Provider Demographics
NPI:1558367680
Name:KELLY-JONES, ALYSE MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:MARGARET
Last Name:KELLY-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AILSE
Other - Middle Name:MARGARET
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:704-495-6324
Practice Address - Street 1:330 BILLINGSLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3096
Practice Address - Country:US
Practice Address - Phone:704-405-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900894207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891218NMedicaid
NCG99422Medicare UPIN
NC2276029BMedicare PIN
NC891218NMedicaid