KELLEY P DOUGLAS MD NPI 1184617474

NPI Information

NPI: 1184617474
Provider Name: KELLEY P DOUGLAS, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
901 18TH ST E
TIFTON, GA
ZIP 31794
Phone: (912) 287-1515
Get Directions

Kelley P Douglas, MD is a diagnostic radiology radiology in Tifton, GA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Kelley P Douglas, MD NPI is 1184617474. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

901 18TH ST E
TIFTON, GA
ZIP 31794-648
Phone: (912) 287-1515
Fax: (912) 287-1394

The enumeration date for this NPI number is 8/23/2005 and was last updated on 11/17/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	033957	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	E81658	MEDICARE UPIN
2	30BDCGQ	MEDICARE PIN	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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