Provider Demographics
NPI:1346200128
Name:KELLY, FRANK B (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:B
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1408
Mailing Address - Country:US
Mailing Address - Phone:478-743-3000
Mailing Address - Fax:478-741-9657
Practice Address - Street 1:1600 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1408
Practice Address - Country:US
Practice Address - Phone:478-743-3000
Practice Address - Fax:478-741-9657
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16539207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000180067CMedicaid
200009711OtherMEDICARE RAILROAD PTAN
GA000180067CMedicaid
GAD45828Medicare UPIN