Healthcare Provider Details

I. General information

NPI: 1174622500
Provider Name (Legal Business Name): MARK C KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 CRESCENT CENTRE DR STE 600
FRANKLIN TN
37067-4687
US

IV. Provider business mailing address

318 LIONHEART CT
FRANKLIN TN
37067-6447
US

V. Phone/Fax

Practice location:
  • Phone: 615-498-8763
  • Fax:
Mailing address:
  • Phone: 615-498-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD29494
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberMD29494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: