Active NPI
John I Kelly, D.C.
- Chiropractor
- Acworth, GA
National Provider Identifier
1255348603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1565
- Practice address
- 5461 Bells Ferry Rd
Acworth, GA 30102-2525 - Phone
- (770) 928-8800
- Fax
- (770) 928-8811
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1565 | GA | Primary |
| Chiropractor | 111N00000X | 828 | OH |
Addresses
Primary practice location
5461 Bells Ferry Rd
Acworth, GA 30102-2525
Mailing address
5461 Bells Ferry Rd
Acworth, GA 30102-2525
Phone (770) 928-8800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141031000938 | GA | Practitioner - Chiropractic | 9739353368 | Practice locations: Acworth, GA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 828 | OH | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322611200000",
"number": "1255348603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5461 BELLS FERRY RD",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301022525",
"telephone_number": "770-928-8800",
"fax_number": "770-928-8811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5461 BELLS FERRY RD",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301022525",
"telephone_number": "770-928-8800",
"fax_number": "770-928-8811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOHN",
"middle_name": "I",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2011-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "GA",
"license": "1565",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OH",
"license": "828",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.