Healthcare Provider Details

I. General information

NPI: 1558343087
Provider Name (Legal Business Name): ALAN DEWITT KENNETT KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 HIGHWAY 28
WHITWELL TN
37397-5373
US

IV. Provider business mailing address

13851 HIGHWAY 28
WHITWELL TN
37397-5373
US

V. Phone/Fax

Practice location:
  • Phone: 423-658-9200
  • Fax:
Mailing address:
  • Phone: 423-658-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72213
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: