Healthcare Provider Details

I. General information

NPI: 1205059169
Provider Name (Legal Business Name): STEPHEN J KELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 14TH AVE S
BIRMINGHAM AL
35205-4969
US

IV. Provider business mailing address

1830 14TH AVE S
BIRMINGHAM AL
35205-4969
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2250
  • Fax: 205-933-2221
Mailing address:
  • Phone: 205-933-2250
  • Fax: 205-933-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28419
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: