Individual
RONALD FULTON KELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4433 LEISURE TIME, DIAMONDHEAD, MS 39525-3259
(228) 586-9229
(228) 586-9230
Mailing address
149 DRINKWATER RD, BAY ST LOUIS, MS 39520-1658
(228) 467-8676
(228) 467-8674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19011
MISSISSIPPI LICENSE
MS
Enumeration date
01/26/2006
Last updated
01/23/2014
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