Healthcare Provider Details

I. General information

NPI: 1285263111
Provider Name (Legal Business Name): MICHAEL PAUL KELLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MADISON ST
THOMASVILLE GA
31792-5473
US

IV. Provider business mailing address

1898 MERCHANTS ROW BLVD UNIT 35
TALLAHASSEE FL
32311-4732
US

V. Phone/Fax

Practice location:
  • Phone: 229-236-3816
  • Fax:
Mailing address:
  • Phone: 614-914-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME166180
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME166180
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number98838
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number98838
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME166180
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number98838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: