Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | DO0000001756 | TN |
NPI | 1205879467 |
---|---|
Provider Name | Dr. Michael Sean Kellogg |
First Address | Hendersonville, TN 37075-2379 |
Second Address | Hendersonville, TN 37075-2379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 31/01/2022 |