Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 29494 | TN |
N | 2086X0206X | Surgical Oncologist | MD29494 | TN |
NPI | 1174622500 |
---|---|
Provider Name | Mark C Kelley |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G24882 | (02) |