Anthony Kellam Jr.

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

A60616220 Issued in VA

Practice address

407 W Little Creek Rd
Norfolk, VA 23505-2301

Phone

(757) 377-6754

NPI assigned

Jan 9, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ajs Mobile Lab Services LLC

  • Community Health Clinic/Center
  • Chesapeake, VA
  • NPI 1164242079
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641686400000",
    "number": "1851052005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W LITTLE CREEK RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235052301",
            "telephone_number": "757-377-6754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W LITTLE CREEK RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235052301",
            "telephone_number": "757-377-6754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLAM",
        "first_name": "ANTHONY",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-09",
        "last_updated": "2022-01-09",
        "certification_date": "2022-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "VA",
            "license": "A60616220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "akellam@me.com",
            "affiliation": "N",
            "endpointDescription": "akellam@me.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "407 W Little Creek Rd",
            "city": "Norfolk",
            "state": "VA",
            "country_code": "US",
            "postal_code": "235052301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lakeisha Keene
• Emily Mae Keener, DO
• Zachary Kegley
• Tyler Anderson Keith, MD
• Jessica Joy Kell, M.D.
• Marilyn S Kellam, MD
• Brian Kelley
• Katrina L. Kelley, RDH
• Nathaniel Kelley, LPC
• Alison M. Kelly, CRNA

• Prevention Professional in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Prevention Professional in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.