Provider Demographics
NPI:1740333269
Name:KELLY, SUZETTE A (MD)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:A
Other - Last Name:HORNSBY-ODOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 25TH AVE N
Mailing Address - Street 2:STE 204
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-620-5151
Mailing Address - Fax:615-620-5155
Practice Address - Street 1:310 25TH AVE N
Practice Address - Street 2:STE 204
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1515
Practice Address - Country:US
Practice Address - Phone:615-620-5151
Practice Address - Fax:615-620-5155
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039878207R00000X
TNMD39878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH22785Medicare UPIN