| Organization Name: | KELLY MEDICAL, INC. |
| NPI Number: | 1386875714 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACK STEVEN KELLY (OWNER) |
| Mailing Address: | 1204 N Lake Park Blvd Unit F. Carolina Beach |
| State: | NC US |
| Postal Code: | 284284163 |
| Phone Number: | 9104587799 |
| Fax Number: | 9104585325 |
| NPI Enumeration Date: | 08/03/2009 |
| NPI Last Update Date: | 11/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 3418849 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |