MEDICARE: ANN GREGORY KELLY M.D.

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	207Q00000X	Family Medicine Physician	84489	SC

General Provider Information

NPI Number	:	1104270651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN GREGORY KELLY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 530062
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0062
Country	:	US
Telephone Number	:	843-695-6071
Fax Number	:	843-569-5879

Provider Business Practice Location Address
First Line	:	418 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2625
Country	:	US
Telephone Number	:	843-795-5362
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	01/19/2026

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