Individual
TIMOTHY KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1903 TURNER MCCALL BLVD SE, ROME, GA 30161-3366
(706) 237-7223
(706) 237-7279
Mailing address
1903 TURNER MCCALL BLVD SE, ROME, GA 30161-3366
(706) 237-7223
(706) 237-7279
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054860421
GEORGIA IDENTIFICATION CARD
GA
Enumeration date
04/01/2019
Last updated
04/01/2019
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