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James Allen Kelly

Social Worker

Behavioral Health & Social Service Providers

5200 Maryland Way, Suite 102, Brentwood, TN 37027-5018

PECOS Enrollment

This provider is enrolled in PECOS as JAMES KELLY.

Based on the most recent information from CMS, provider James Allen Kelly is legally eligible to order and refer claims for DME services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:54 AM.

Profile Details

Provider ID
1942327952
Provider Type
Individual
Full Name
Kelly, James Allen
Title
Mr.
Credential
L.C.S.W.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
3/23/2007
Last Updated
7/8/2007

Contact Information

Practice Location

5200 Maryland Way, Suite 102, Brentwood, TN 37027-5018

(615) 377-1153

(615) 370-0919

Mailing Location

5200 Maryland Way, Suite 102, Brentwood, TN 37027-5018

(615) 377-1153

(615) 370-0919

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 686 Tennessee

Provider Identifiers

ID	Description	Issuer
ID 0085513	Description Other	Issuer BCBS PROVIDER NUMBER Tennessee

James Allen Kelly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Cohen, Lynn Faust

Waymier, Paula P.

Waters, Raquel

Southworth, Donna B

Trevathan, Lauren Olivia

Matty, Maria

Jones, Andrea

Bowman, Madelyn Whitley

Covington, Alicia Marie

Sechser, Lindsay