Kellum, Mark J
Kellum, Mark J is an individual health care provider with primary practice located at 1793 Cliff Gookin Blvd , Tupelo MS 38801-6723. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Kellum, Mark J can be contacted via phone (662) 842-1161.Contact Information
Primary practice address
1793 Cliff Gookin Blvd
Tupelo MS 38801-6723
Phone: (662) 842-1161
Fax: (662) 844-4107
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 11046 | Mississippi |
Profile Details
| NPI number | 1881665859 |
|---|---|
| LBN Legal business name | Kellum, Mark J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 30th, 2006 |
| Last updated | Jun 21st, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881665859 | NPPES |
| Mississippi | MEDICAID | 00115201 |
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