Provider Demographics
NPI:1538166202
Name:VOKOUN, KELLY J (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:VOKOUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6835
Mailing Address - Country:US
Mailing Address - Phone:912-673-8005
Mailing Address - Fax:912-673-6411
Practice Address - Street 1:2040 DAN PROCTOR DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3811
Practice Address - Country:US
Practice Address - Phone:912-673-8000
Practice Address - Fax:912-673-8003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA45195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
37BBGRKMedicare ID - Type Unspecified
H62966Medicare UPIN