MEDICARE: KELSEY ALLEN M.D.

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	208000000X	Pediatrics Physician	LL39481	SC
2	208000000X	Pediatrics Physician	38481	SC
3	208000000X	Pediatrics Physician	92666	GA

General Provider Information

NPI Number	:	1942658547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY ALLEN M.D.

Provider Business Mailing Address
First Line	:	211 LUCERNE ST
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-8905
Country	:	US
Telephone Number	:	404-785-7141
Fax Number	:

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	07/27/2022

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