Healthcare Provider Details

I. General information

NPI: 1851381164
Provider Name (Legal Business Name): JOHN A GELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 TOWER RD NE
MARIETTA GA
30060-6977
US

IV. Provider business mailing address

54 TOWER RD NE
MARIETTA GA
30060-6977
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-4682
  • Fax: 770-499-8562
Mailing address:
  • Phone: 770-427-4682
  • Fax: 770-499-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number026528
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: