Provider Demographics
NPI:1376751354
Name:KELLEY, JOSEPH R (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GENESISCARE USA OF NORTH CAROLINA
Mailing Address - Street 2:20 MEDICAL PARK
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-0028
Mailing Address - Country:US
Mailing Address - Phone:828-253-7077
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:GENESISCARE USA OF NORTH CAROLINA
Practice Address - Street 2:20 MEDICAL PARK
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1545
Practice Address - Country:US
Practice Address - Phone:828-253-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-021492085R0001X
WAMD602615492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532833Medicaid
TN103I924884Medicare PIN