Provider Demographics
NPI:1407114184
Name:MOHAMED KELLI, HEVAL (MD)
Entity Type:Individual
Prefix:
First Name:HEVAL
Middle Name:
Last Name:MOHAMED KELLI
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 1:1462 CLIFTON RD NE
Mailing Address - Street 2:SUITE #513
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1000
Mailing Address - Country:US
Mailing Address - Phone:404-727-9281
Mailing Address - Fax:
Practice Address - Street 1:721 WELLNESS WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3304
Practice Address - Country:US
Practice Address - Phone:404-962-6030
Practice Address - Fax:404-962-6031
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072984207R00000X
GA72984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine