Provider Demographics
NPI:1720421084
Name:KELSEY, JAMES TALCOTT JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TALCOTT
Last Name:KELSEY
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:COTTER
Other - Middle Name:
Other - Last Name:KELSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:126 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7069
Mailing Address - Country:US
Mailing Address - Phone:203-820-8055
Mailing Address - Fax:
Practice Address - Street 1:107 PILGRIM VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9240
Practice Address - Country:US
Practice Address - Phone:404-850-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1687171100000X
CA14598171100000X
GA485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist