Individual
GARRETT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1168 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-2444
(757) 352-2020
(757) 686-0541
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102036923
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010021235
—
VA
01
—
122066
SENTARA/OPTIMA
VA
01
—
171965
ANTHEM
VA
01
—
4084676
AETNA
VA
01
—
541595397
MID ATLANTIC SOLUTIONS
VA
Enumeration date
02/13/2006
Last updated
04/06/2021
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