Provider Demographics
NPI:1407114184
Name:MOHAMED KELLI, HEVAL (MD)
Entity type:Individual
Prefix:
First Name:HEVAL
Middle Name:
Last Name:MOHAMED KELLI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7765
Mailing Address - Country:US
Mailing Address - Phone:404-845-8200
Mailing Address - Fax:
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7765
Practice Address - Country:US
Practice Address - Phone:404-845-8200
Practice Address - Fax:404-962-6031
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72984207RC0000X
GA072984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine