Kelly, Jerry
Kelly, Jerry is an sole proprietor health care provider with primary practice located at 1061 Harmon Ave , Fort Stewart GA 31314-5641. He recently has only one registered license in Other Service Providers / Military Health Care Provider, which is considered as his primary health care specialty. Kelly, Jerry can be contacted via phone (912) 435-5211.Contact Information
Primary practice address
1061 Harmon Ave
Fort Stewart GA 31314-5641
Phone: (912) 435-5211
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Military Health Care Provider | 171000000X | E3038628 |
Profile Details
| NPI number | 1043611783 |
|---|---|
| LBN Legal business name | Kelly, Jerry |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 12th, 2014 |
| Last updated | Sep 12th, 2014 - about 11 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 | 1043611783 | NPPES |
| Other | E3038628 | NREMT |
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