| Organization Name: | KELLY IMAGING GROUP, LLC |
| NPI Number: | 1033400759 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DON GARDNER (CO-FOUNDER, VICE PRESIDENT) |
| Mailing Address: | 112 Cosgrove Ln Taylors |
| State: | SC US |
| Postal Code: | 296874106 |
| Phone Number: | 8642484080 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2011 |
| NPI Last Update Date: | 07/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471S1302X |
| License Number: | 46001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Sonography |
| Taxonomy Definition: | |