Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Shem Kearney Blackley IV, MD

Individual provider Surgery Physician · NPI 1649857202

Dr. Shem Kearney Blackley IV, MD is a General Surgery in Winston Salem, North Carolina. Graduated from Wake Forest University School of Medicine in 2021, 5 years ago. Licensed in Alabama and North Carolina.

Years since qualifying
5
Trained at
Wake Forest University School of Medicine
Licensed in
AL, NC
In the registry since
2021
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1 Medical Center Blvd
Winston Salem, NC 27157-0001
Phone: (336) 713-4211
Fax: (336) 716-9758
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 2026-02846 (NC)
Surgery Physician Taxonomy 208600000X · Licence MD.45368 (AL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1649857202
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 28, 2021
Last updated in NPPESJune 19, 2026
Certification dateJune 19, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolWAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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