Healthcare Provider Details

I. General information

NPI: 1831196203
Provider Name (Legal Business Name): KELLI GAY SMITH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/27/2022
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 HAYNES BRIDGE RD STE 205-309
ALPHARETTA GA
30009-1966
US

IV. Provider business mailing address

11770 HAYNES BRIDGE RD STE 205-309
ALPHARETTA GA
30009-1966
US

V. Phone/Fax

Practice location:
  • Phone: 833-244-3275
  • Fax: 833-244-3275
Mailing address:
  • Phone: 833-244-3275
  • Fax: 833-244-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: