MEDICARE: MS. KELLEY E HUBBARD CRNA MBA MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP1183292	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659348688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLEY E HUBBARD CRNA MBA MS

Provider Business Mailing Address
First Line	:	575 PROFESSIONAL DR STE 165
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-3300
Country	:	US
Telephone Number	:	770-277-3056
Fax Number	:	855-204-5244

Provider Business Practice Location Address
First Line	:	3193 HOWELL MILL RD NW STE 315
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2100
Country	:	US
Telephone Number	:	888-408-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/14/2018

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