Provider Demographics
NPI:1295738748
Name:KELLY, JAMES BERNARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BERNARD
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3240 EDWARDS LAKE PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3128
Mailing Address - Country:US
Mailing Address - Phone:205-949-2020
Mailing Address - Fax:205-949-1400
Practice Address - Street 1:3240 EDWARDS LAKE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3128
Practice Address - Country:US
Practice Address - Phone:205-949-2020
Practice Address - Fax:205-949-1400
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00004234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51553350Medicare ID - Type Unspecified
ALC15196Medicare UPIN