MEDICARE: DR. BURNETT S KELLY 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
1	204F00000X	Transplant Surgery Physician	A83773	CA
2	204F00000X	Transplant Surgery Physician	40226	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40226	OTHER	TN	MEDICAL
2	00A837730	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1427083211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BURNETT S KELLY MD

Provider Business Mailing Address
First Line	:	6104 ROBIN HILL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-3230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 21ST AVE S
Second Line	:	OXFORD HOUSE SUITE 801
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0001
Country	:	US
Telephone Number	:	615-936-3427
Fax Number	:	615-936-0435

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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