Provider Demographics
NPI:1922771799
Name:KELLY FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:KELLY FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-686-5232
Mailing Address - Street 1:2298 US HIGHWAY 70 UNIT A
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-8209
Mailing Address - Country:US
Mailing Address - Phone:828-686-5232
Mailing Address - Fax:828-686-7712
Practice Address - Street 1:2298 US HIGHWAY 70 UNIT A
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-8209
Practice Address - Country:US
Practice Address - Phone:828-686-5232
Practice Address - Fax:828-686-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty