Individual
JASON LEE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 BAILEY COVE RD SE, HUNTSVILLE, AL 35802-4002
(256) 428-4900
(256) 428-4912
Mailing address
PO BOX 2705, HUNTSVILLE, AL 35804-2705
(256) 801-6048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33261
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193074
—
AL
Enumeration date
06/17/2011
Last updated
08/31/2021
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