Individual
DR. JUSTIN KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1401 BONE CREEK DR, SANDUSKY, OH 44870-7267
(419) 625-4900
(419) 627-9768
Mailing address
628 SPIVEY CAMP RD, KINSTON, AL 36453-7030
(334) 399-9555
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
34.014089
OH
207XX0801X
Orthopaedic Trauma Physician
34.014089
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0381932
—
OH
01
—
34.014089
LICENSE
OH
Enumeration date
04/18/2014
Last updated
08/21/2020
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