DR. JOHN WILSON KELLY IV (NPI# 1194104802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194104802 |
| Entity Type | Individual |
| Full Name | DR. JOHN WILSON KELLY IV |
| Credential | M.D. |
| Practice Address |
800 N Fant St Anderson SC 29621-5708 |
| Mailing Address |
143 Mediterranean Ave Anderson SC 29621-4293 |
| Practice Telephone | 8645121000 |
| Mailing Telephone | 8034274827 |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2019-02-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD51998 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 1194104802 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 Lothrop St, Pittsburgh, PA 152132536 | 4126478762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902412893 | John Kelly | Home Health Aide | 337 Great Oaks Trl, Wadsworth, OH 44281-9427 | 2020-09-16 |
| 1952969826 | John Kelly | Community Health Worker | 4048 Crestwood Dr, Wausau, WI 54403-8122 | 2019-06-04 |
| 1629530712 | John J Kelly | Otolaryngology | 579 W Moorwood St, Green Valley, AZ 85614-5980 | 2019-04-05 |
| 1851886568 | John D Kelly | Counselor | 481 8th Ave Ste 520, New York, NY 10001-1809 | 2018-06-25 |
| 1255876041 | John Edward Kelly | Physician Assistant | 1340 Citizens Blvd, Leesburg, FL 34748-3924 | 2017-01-03 |
| 1225487986 | John Kelly | Pharmacist | 3761 Knollcroft St, Easton, PA 18045-3026 | 2016-06-03 |
| 1588023246 | John Kelly | Behavior Technician | 1118 Poindexter Ave W, Bremerton, WA 98312-4337 | 2016-02-23 |
| 1760880173 | John Kelly | Dentist | 4833 Bethesda Ave Ste 302, Bethesda, MD 20814-5244 | 2014-12-17 |
| 1508135252 | John Kelly | Counselor | 4550 Lantana Road, Suite A4, Lake Worth, FL 33463 | 2011-12-27 |
| 1497055008 | John Peter Kelly | Occupational Therapist | 21 Dorothy Ln, Kings Park, NY 11754-2932 | 2010-10-28 |
| Street Address |
800 N FANT ST |
| City | ANDERSON |
| State | SC |
| Zip Code | 29621-5708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730182262 | Sarah Anne Cummings | Nurse Anesthetist, Certified Registered | 800 N Fant St, Anderson, SC 29621-5708 | 2005-05-30 |
| 1922623677 | Ivy Ray | Nurse Practitioner | 800 N Fant St, Anderson, SC 29621-5708 | 2020-06-09 |
| 1003431701 | Jennifer E Thompson | Pharmacist | 800 N Fant St, Anderson, SC 29621-5708 | 2020-06-09 |
| 1174165054 | Heather Marshall Ford | Nurse Practitioner | 800 N Fant St, Anderson, SC 29621-5708 | 2019-10-12 |
| 1700349206 | Carleen O'connell | Registered Nurse | 800 N Fant St, Anderson, SC 29621-5708 | 2019-04-11 |
| 1942769666 | Dharti Patel | Nurse Practitioner | 800 N Fant St, Anderson, SC 29621-5708 | 2019-03-13 |
| 1760940225 | Meredith H Hargrove | Nurse Practitioner | 800 N Fant St, Anderson, SC 29621-5708 | 2019-03-04 |
| 1780169276 | Brent Austin Harris | Nurse Practitioner | 800 N Fant St, Anderson, SC 29621-5708 | 2018-10-01 |
| 1356826929 | Donna Annette Patterson | Registered Nurse | 800 N Fant St, Anderson, SC 29621-5708 | 2018-09-30 |
| 1174002059 | Ich Er Services, LLC | Emergency Medicine | 800 N Fant St, Anderson, SC 29621-5708 | 2018-08-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114574241 | Kathryn L Harwick | Social Worker | 3030 Sc-81, Anderson, SC 29621 | 2019-08-22 |
| 1326517194 | Ashlea Bronwen Bates | Nurse Practitioner | 3424 Clemson Blvd., Anderson, SC 29621 | 2018-11-21 |
| 1770051708 | Bailee Vernon Mccarley | Nurse Practitioner | 800 Fant St, Anderson, SC 29621 | 2018-11-07 |
| 1790278893 | Morgan Cutts | Speech-Language Pathologist | 126 Broadbent Way, Suite A, Anderson, SC 29621 | 2018-06-13 |
| 1427546233 | Amanda Coker Burnette | Family Medicine | 3000 East Greenville Street, Suite 3700, Anderson, SC 29621 | 2018-04-26 |
| 1205342169 | Robert Allen Dameron Jr. | Orthopaedic Surgery | 130 Longview Drive, Anderson, SC 29621 | 2017-12-14 |
| 1578085411 | Michael Jason Bell | Contractor | 520 Hwy 29 Bypass N, Anderson, SC 29621 | 2017-07-12 |
| 1639629983 | Todd E. Hamilton | Dentist | 1112 Cornelia Road, Anderson, SC 29621 | 2016-10-11 |
| 1760939110 | Crystal Vaughn | Nurse Practitioner | Sac Anmed Health 2000 East Greenville Street, Anderson, SC 29621 | 2016-09-01 |
| 1992151328 | Veronica Williams | Non-emergency Medical Transport (VAN) | 2314 Old Williamston Road, Anderson, SC 29621 | 2016-05-04 |
| Find all providers in zip 29621 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093156580 | Vipin Verma | Internal Medicine | 703 N Fant St Ste B, Anderson, SC 29621-5705 | 2013-07-11 |
| 1528320918 | James Thompson Mcclain | Internal Medicine | 2000 E Greenville St Ste 5000, Anderson, SC 29621-1763 | 2012-06-12 |
| 1548540578 | Emerald Banas Branch | Internal Medicine | 2000 East Greenville St., Suite 1100, Anderson, SC 29621 | 2011-08-22 |
| 1023345972 | Dalwinderpal Singh Samra | Internal Medicine | 1547 Ohio Ave., Anderson, IN 46016-5088 | 2009-11-13 |
| 1871759100 | Heather G Figurelli | Internal Medicine | 2101 Jackson St Ste 101, Anderson, IN 46016-4386 | 2008-08-06 |
| 1720242183 | Ravi Kant | Internal Medicine | 100 Healthy Way Ste 1210, Anderson, SC 29621 | 2008-07-15 |
| 1821251240 | David Jonathan Budhoo | Internal Medicine | 118 Carter Hall Dr, Anderson, SC 29621-1904 | 2008-07-07 |
| 1386856037 | Nighat A Tahir | Internal Medicine | 1210a Medical Arts Blvd, Suite 200, Anderson, IN 46011-3437 | 2007-05-04 |
| 1356477368 | Charles W. Scowcroft | Internal Medicine | 1530 N Fant St Ste B, Anderson, SC 29621-4700 | 2007-02-26 |
| 1790851509 | Robert W Anderson | Internal Medicine | 2101 Jackson Street, Suite 111, Anderson, IN 46016 | 2006-11-27 |
| Find all providers in ANDERSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.