Individual
KELVIN L. DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2156-B N. HIGHLAND AVE, STE 282, JACKSON, TN 38305
(731) 499-2791
(731) 285-5200
Mailing address
1505 WOODLAWN AVE, STE A, DYERSBURG, TN 38024
(731) 287-1500
(731) 285-5200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26349
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171276
—
TN
05
—
17154
—
TN
05
—
3090776
—
TN
05
—
35464
—
TN
01
—
4106545
BCBST
TN
05
—
4106545
—
TN
Enumeration date
06/06/2006
Last updated
07/09/2007
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