Provider Demographics
NPI:1801859426
Name:KELLEY, JOHN P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KELLEY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1459 MONTREAL RD
Mailing Address - Street 2:STE 309
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-493-1812
Mailing Address - Fax:770-938-5454
Practice Address - Street 1:1459 MONTREAL RD
Practice Address - Street 2:STE 309
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-493-1812
Practice Address - Fax:770-938-5454
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA024276207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E61257Medicare UPIN