Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD17353 | TN |
N | 207QA0505X | Family Doctor - Adult Medicine | MD0000017353 | TN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD17353 | TN |
NPI | 1366556201 |
---|---|
Provider Name | Dr. Earl Lee Kelly |
First Address | Nashville, TN 37221 |
Second Address | Clarksville, TN 37043-4523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 10/09/2014 |