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NPI Code Detail

MEDICARE: DR. KEELY IANNELLI MD

MEDICARE: DR. KEELY IANNELLI MD
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
12080C0008XChild Abuse Pediatrics Physician100695GA
2208000000XPediatrics Physician157664FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154884807
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEELY IANNELLI MD
Provider Business Mailing Address
First Line : 975 JOHNSON FY RD NE STE 350
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4735
Country : US
Telephone Number : 404-785-2003
Fax Number : 404-785-3850
Provider Business Practice Location Address
First Line : 975 JOHNSON FY RD NE STE 350
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4735
Country : US
Telephone Number : 404-785-2003
Fax Number : 404-785-3850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 04/21/2026

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