Individual
JOHN WILLIAM KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
890 W FARIS RD, STE 520, GREENVILLE, SC 29605-4253
(864) 455-9033
(864) 455-6559
Mailing address
1 INDEPENDENCE PT, STE 212, GREENVILLE, SC 29615-4545
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
17203
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110247976
RR MEDICARE
SC
05
—
172039
—
SC
Enumeration date
05/19/2006
Last updated
07/21/2016
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