Nicholas Owen Kelley, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35675 Issued in SC

Practice address

125 Clairemont Ave Ste 190
Decatur, GA 30030

Phone

(404) 748-9691

NPI assigned

Nov 13, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Childfren'S Medical Group, P.C.

  • Pediatric Adolescent Medicine Physician
  • Atlanta, GA
  • NPI 1497865935
  NPD (past)
• Edward M. Gotlieb, M.D., Et Al Dba the Pediatric Center

  • Pediatrics Physician
  • Stone Mountain, GA
  • NPI 1619197498
  NPD (past)

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1861729709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 CENTURY BLVD NE STE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453323",
            "telephone_number": "404-633-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CLAIREMONT AVE STE 190",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "30030",
            "telephone_number": "404-748-9691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 E Broad St",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "296033233",
            "country_code": "US",
            "telephone_number": "864-707-2135",
            "fax_number": "864-707-2136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "NICHOLAS",
        "middle_name": "OWEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-13",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "35675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356750",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Keel, LCSW
• Martha R Keeling, LPC
• Melissa Keene, RRT
• Jamison Keenum
• Leah Michelle Kelley, LMSW
• Porsha Mariah Kelley, MSN, APRN, FNP-C
• Sydney Cosette Kelley
• Yulonda Yvette Kelley, MA,LPC
• Angela Yvonne Kelliebrew
• Phillip Schuyler Kellogg, DPT

• Pediatrics Physician in Decatur, GA
• Providers in Decatur, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.