MEDICARE: KELLY J. HULSEY 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	208000000X	Pediatrics Physician	45832	GA

General Provider Information

NPI Number	:	1316046105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J. HULSEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 655
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30503-0655
Country	:	US
Telephone Number	:	770-536-1245
Fax Number	:	770-536-7989

Provider Business Practice Location Address
First Line	:	200 PRIOR ST SE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3449
Country	:	US
Telephone Number	:	770-536-1245
Fax Number	:	770-536-7989

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/09/2007

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