Provider Demographics
NPI:1134172588
Name:KELLY, IRIS CHAMBLISS (MD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:CHAMBLISS
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HEMLOCK ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8329
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:478-745-8932
Practice Address - Street 1:657 HEMLOCK ST
Practice Address - Street 2:SUITE 220
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8329
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:478-745-8932
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23070207R00000X
GA51448208M00000X
GA051488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5562814OtherCIGNA
SC57-6007863095OtherBCBS OF SC
SC230707Medicaid
SC57-6007863071OtherBLUE CHOICE OF SC
SC7649442OtherAETNA
SC57-6007863095OtherBCBS OF SC
SC5562814OtherCIGNA
SC5562814OtherCIGNA