Provider Demographics
NPI:1760554877
Name:KELLAM, PAUL DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:KELLAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:102 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2500
Mailing Address - Country:US
Mailing Address - Phone:478-272-8382
Mailing Address - Fax:478-272-8464
Practice Address - Street 1:102 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2500
Practice Address - Country:US
Practice Address - Phone:478-272-8382
Practice Address - Fax:478-272-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034168207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF81373Medicare UPIN
GA04BDBLMMedicare ID - Type Unspecified