Provider Demographics
NPI:1831198118
Name:BEWSEY, KELLY EUGENE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:EUGENE
Last Name:BEWSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3977
Mailing Address - Country:US
Mailing Address - Phone:423-581-6084
Mailing Address - Fax:865-374-2140
Practice Address - Street 1:619 S 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:470-267-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424055208800000X
IL036116610208800000X
TN58220208800000X
GA98929208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045916Medicaid
PA100944016001Medicaid
IL036116610Medicaid
IL979010Medicare PIN
I10427Medicare UPIN
080951Medicare ID - Type Unspecified
ILK29730Medicare ID - Type UnspecifiedPIN PEKIN
PA100944016001Medicaid