Individual
SCOTT ASBURY KELLERMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501
(770) 535-9391
(770) 533-4701
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 533-6511
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101223420
VA
2085R0202X
Diagnostic Radiology Physician
Primary
59803
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007223676
—
VA
05
—
123832240G
—
GA
01
—
LICENSE
0101223420
VA
Enumeration date
08/20/2006
Last updated
03/06/2019
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