Healthcare Provider Details

I. General information

NPI: 1518679307
Provider Name (Legal Business Name): BYRON KELLAM & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD STE 400T
ATLANTA GA
30337-5609
US

IV. Provider business mailing address

3292 THORNECREEK DR
DOUGLASVILLE GA
30135-8124
US

V. Phone/Fax

Practice location:
  • Phone: 470-213-3568
  • Fax: 770-577-2887
Mailing address:
  • Phone: 470-213-3568
  • Fax: 770-577-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BYRON KELLAM
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LPC, CPCS
Phone: 470-213-3568