Provider Demographics
NPI:1366556201
Name:KELLY, EARL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:LEE
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4904 TRACEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221
Mailing Address - Country:US
Mailing Address - Phone:931-221-2171
Mailing Address - Fax:931-221-2173
Practice Address - Street 1:1731 MEMORIAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4523
Practice Address - Country:US
Practice Address - Phone:931-221-2171
Practice Address - Fax:931-221-2173
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD17353207Q00000X, 207QG0300X
TNMD0000017353207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine