Doctor Name: | DR. MICHAEL JAMES KELLY |
NPI Number: | 1801044714 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 35228 |
Business Practice Address: | 300 W Hospital Rd Eisenhower Army Medical Center Fort Gordon, GA - 309055741 |
Business Phone Number: | 5043196598 |
Business Fax Number: | |
Mailing Address: | 300 W Hospital Rd, Eisenhower Army Medical Center FORT GORDON |
State: | GA |
Postal Code: | 309055741 |
Phone Number: | 5043196598 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2008 |
NPI Last Update Date: | 08/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35228 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |