Provider Demographics
NPI:1689016925
Name:GOLD HILL FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:GOLD HILL FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-782-9175
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0215
Mailing Address - Country:US
Mailing Address - Phone:704-209-0418
Mailing Address - Fax:
Practice Address - Street 1:11055 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-9792
Practice Address - Country:US
Practice Address - Phone:704-209-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty