Organization
KENJACK MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARRETT M KELLY D.O. (PRESIDENT)
(757) 274-4452
Entity
Organization
Contact information
Practice address
951 W 21ST ST, NORFOLK, VA 23517-1534
(757) 274-4452
(757) 531-7723
Mailing address
951 W 21ST ST, NORFOLK, VA 23517-1534
(757) 274-4452
(757) 531-7723
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102036923
VA
Other
Enumeration date
12/17/2015
Last updated
05/01/2017
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