MEDICARE: DR. TIMOTHY P KELLY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR002569	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	581926737	OTHER	GA	FED ID #

General Provider Information

NPI Number	:	1063592558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY P KELLY D.C.

Provider Business Mailing Address
First Line	:	3098 PIEDMONT RD NE STE 430
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2600
Country	:	US
Telephone Number	:	404-477-1589
Fax Number	:

Provider Business Practice Location Address
First Line	:	3098 PIEDMONT RD NE STE 430
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2600
Country	:	US
Telephone Number	:	404-477-1589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. TIMOTHY P KELLY D.C.” Practice Location

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