=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760897185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY CHOHONIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2014
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 TRANSMOUNTAIN RD STE B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79911-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-215-8400
-----------------------------------------------------
Fax | 915-612-9254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 EAST HOSPITAL RD
-----------------------------------------------------
City | FORT GORDON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-4657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 29000
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | V4098
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------