Organization
KEVIN G. KELLY, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN G. KELLY M.D. (OWNER)
(256) 332-5901
Entity
Organization
Contact information
Practice address
13150 HIGHWAY 43, SUITE 10, RUSSELLVILLE, AL 35653-4558
(256) 332-5901
(256) 332-6911
Mailing address
13150 HIGHWAY 43, SUITE 10, RUSSELLVILLE, AL 35653-4558
(256) 332-5901
(256) 332-6911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8497
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000001253
—
AL
Enumeration date
01/03/2011
Last updated
01/03/2011
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