Provider Demographics
NPI:1326041757
Name:KELLEY, SCOTT T (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:840 MONTCLAIR RD
Mailing Address - Street 2:STE 500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1946
Mailing Address - Country:US
Mailing Address - Phone:205-595-5504
Mailing Address - Fax:205-595-3427
Practice Address - Street 1:840 MONTCLAIR RD
Practice Address - Street 2:STE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1946
Practice Address - Country:US
Practice Address - Phone:205-595-5504
Practice Address - Fax:205-595-3427
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL14805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE20801Medicare UPIN