Provider Demographics
NPI:1659356236
Name:JOLLEY, KELLIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:A
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1700 BROAD ST STE 140
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1834
Practice Address - Country:US
Practice Address - Phone:423-493-5240
Practice Address - Fax:423-493-5241
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN30471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG71596Medicare UPIN