Individual
DR. BRAD RICHARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1000 PINE ST W, VARNVILLE, SC 29944-4750
(803) 943-7702
Mailing address
1000 PINE ST W, VARNVILLE, SC 29944-4750
(803) 943-7702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39359
SC
207Q00000X
Family Medicine Physician
58.005341
OH
207Q00000X
Family Medicine Physician
R3239
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393596
—
SC
Enumeration date
07/28/2014
Last updated
05/11/2020
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