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Individual

JERRY KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-5211
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-5211

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
E3038628

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
E3038628
NREMT
Enumeration date
09/12/2014
Last updated
09/12/2014
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