Provider Demographics
NPI:1578589529
Name:KELLEY, CHRISTOPHER GORDON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GORDON
Last Name:KELLEY
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 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5216
Mailing Address - Country:US
Mailing Address - Phone:256-547-7417
Mailing Address - Fax:256-547-7414
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5216
Practice Address - Country:US
Practice Address - Phone:256-547-7417
Practice Address - Fax:256-547-7414
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22251207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL22251OtherSTATE MED. LIC. BD.
BK5936111OtherDEA
AL22251OtherSTATE MED. LIC. BD.
G98386Medicare UPIN