Individual
MR. CHRISTOPHER LEE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6704 WHITE HORSE RD, GREENVILLE, SC 29611-2504
(864) 294-1392
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6311
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1780
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303PA
—
SC
Enumeration date
09/24/2011
Last updated
06/29/2020
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