Active NPI
Benjamin J Kelly, M.D.
- Specialist
- Woodstock, GA
National Provider Identifier
1073599833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 48120
- Practice address
- 100 Stoneforest Dr Ste 320
Woodstock, GA 30189-4881 - Phone
- (770) 516-5199
- Fax
- (678) 213-1851
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 48120 | GA | Primary |
Addresses
Primary practice location
100 Stoneforest Dr Ste 320
Woodstock, GA 30189-4881
Mailing address
100 Stoneforest Dr 320
Woodstock, GA 30189-4881
Phone (770) 516-5199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48120 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444867200000",
"number": "1073599833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 STONEFOREST DR 320",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301894881",
"telephone_number": "770-516-5199",
"fax_number": "678-213-1851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 STONEFOREST DR STE 320",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301894881",
"telephone_number": "770-516-5199",
"fax_number": "678-213-1851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "BENJAMIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2015-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "48120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.