Individual
JACOB ISAAC KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
78 DAWSON VILLAGE WAY N, STE 230, DAWSONVILLE, GA 30534-7168
(678) 865-8449
(678) 865-8451
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 362-8684
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
GA
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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