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NPI Code Detail

MEDICARE: KELLY HOMLAR MD

MEDICARE: KELLY HOMLAR 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
1207X00000XOrthopaedic Surgery Physician067466GA

General Provider Information

NPI Number : 1295882017
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY HOMLAR MD
Provider Business Mailing Address
First Line : 1499 WALTON WAY
Second Line : SUITE 1400
City : AUGUSTA
State : GA
Zip : 30901-2602
Country : US
Telephone Number : 706-724-6100
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W WHEELER PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6625
Country : US
Telephone Number : 706-869-1515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 07/16/2013

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