Healthcare Provider Details

I. General information

NPI: 1669666814
Provider Name (Legal Business Name): JANETTA M KELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

PO BOX 191472
ATLANTA GA
31119-1472
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1311
  • Fax:
Mailing address:
  • Phone: 404-323-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34169
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034169
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: