Provider Demographics
NPI:1750562344
Name:KELLY, JOHN H JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-0367
Mailing Address - Country:US
Mailing Address - Phone:540-483-7775
Mailing Address - Fax:
Practice Address - Street 1:350 TANYARD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1554
Practice Address - Country:US
Practice Address - Phone:540-483-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012415932083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine