| Doctor Name: | DR. KELLY A BOOTH |
| NPI Number: | 1437141314 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 9700449 |
| Business Practice Address: | 1054 Burrage Rd Ne Concord, NC - 280252910 |
| Business Phone Number: | 7044037800 |
| Business Fax Number: | 7044037810 |
| Mailing Address: | 1054 Burrage Rd Ne, CONCORD |
| State: | NC |
| Postal Code: | 280252910 |
| Phone Number: | 7044037800 |
| Fax Number: | 7044037810 |
| NPI Enumeration Date: | 08/17/2005 |
| NPI Last Update Date: | 10/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/23/2006 |
| NPI Reactivation Date: | 03/27/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 9700449 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |