Kelly, Mark

Kelly, Mark is an individual health care provider with primary practice located at 1220 Jefferson St , Laurel MS 39440-4355. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kelly, Mark can be contacted via phone (601) 426-4507.

Contact Information

Primary practice address
1220 Jefferson St Laurel MS 39440-4355
Phone: (601) 426-4507
Fax: (601) 426-4228
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 17057 Mississippi

Profile Details

NPI number 1457394090
LBN Legal business name Kelly, Mark
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Feb 11th, 2014 - about 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457394090 NPPES
Mississippi MEDICAID 00124357

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