Provider Demographics
NPI:1962678391
Name:STEPHEN JOSEPH KELLY, MD
Entity Type:Organization
Organization Name:STEPHEN JOSEPH KELLY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-933-2250
Mailing Address - Street 1:1830 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4969
Mailing Address - Country:US
Mailing Address - Phone:205-933-2250
Mailing Address - Fax:205-933-2221
Practice Address - Street 1:1830 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4969
Practice Address - Country:US
Practice Address - Phone:205-933-2250
Practice Address - Fax:205-933-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700254OtherMEDICARE
AL51011550OtherBLUE CROSS
AL510G700254OtherMEDICARE