Individual
DR. RICHARD JEAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
840 STEVENS CREEK RD, AUGUSTA, GA 30907-9251
(706) 722-6957
(706) 722-7454
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 774-7263
(706) 774-7230
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
031045
GA
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
031045
GA
2085N0700X
Neuroradiology Physician
031045
GA
2085N0904X
Nuclear Radiology Physician
Primary
031045
GA
2085P0229X
Pediatric Radiology Physician
031045
GA
2085R0202X
Diagnostic Radiology Physician
031045
GA
2085U0001X
Diagnostic Ultrasound Physician
031045
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00368618B
—
GA
05
—
00368618C
—
GA
05
—
00368618E
—
GA
05
—
00368618F
—
GA
05
—
00368618G
—
GA
05
—
00368618H
—
GA
05
—
00368618I
—
GA
05
—
00368618J
—
GA
01
—
10058872
AMERIGROUP
—
05
—
102613
—
SC
01
—
1265540314
NPI - BROWN & RADIOLOGY
—
Enumeration date
04/17/2006
Last updated
04/03/2019
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