Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 65447 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 65447 | GA |
NPI | 1205002748 |
---|---|
Provider Name | Dr. Wayne Kelley JR. |
First Address | Macon, GA 31210 |
Second Address | Macon, GA 31210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 28/12/2012 |