MEDICARE: KELLY EUGENE BEWSEY 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	208800000X	Urology Physician	MD424055	PA
2	208800000X	Urology Physician	036116610	IL
3	208800000X	Urology Physician	58220	TN
4	208800000X	Urology Physician	98929	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1831198118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY EUGENE BEWSEY M.D.

Provider Business Mailing Address
First Line	:	701 MCFARLAND ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3977
Country	:	US
Telephone Number	:	423-581-6084
Fax Number	:	865-374-2140

Provider Business Practice Location Address
First Line	:	619 S 8TH ST STE 304
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	470-267-2940
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/11/2025

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