Healthcare Provider Details

I. General information

NPI: 1952701179
Provider Name (Legal Business Name): MAVIS KELLEY CHHC, AADP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 VERDANT DR SW APT 1505
ATLANTA GA
30331-3086
US

IV. Provider business mailing address

3227 VERDANT DR SW APT 1505
ATLANTA GA
30331-3086
US

V. Phone/Fax

Practice location:
  • Phone: 404-414-9911
  • Fax:
Mailing address:
  • Phone: 404-414-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: