Provider Demographics
NPI:1265549976
Name:KELLY, WOODROW TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:WOODROW
Middle Name:TIMOTHY
Last Name:KELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9390 FORD AVE SUITE 2
Mailing Address - Street 2:WOODROW TIMOTHY KELLY DC
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-756-8080
Mailing Address - Fax:912-756-8170
Practice Address - Street 1:9390 FORD AVE SUITE 2
Practice Address - Street 2:KELLY CHIROPRACTIC PC
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-8080
Practice Address - Fax:912-756-8170
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85101Medicare UPIN
GA35ZCHLDMedicare ID - Type Unspecified