Individual
AMANDA GAYLE O'KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
727 SE MAIN ST, SUITE 320, SIMPSONVILLE, SC 29681-3247
(864) 454-6440
(864) 454-6445
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-2286
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29908
SC
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
29908
SC
208000000X
Pediatrics Physician
29908
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299082
—
SC
Enumeration date
06/14/2007
Last updated
03/23/2024
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