Healthcare Provider Details

I. General information

NPI: 1891334389
Provider Name (Legal Business Name): KELLY ZAVOLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 NORTHEAST EXPY NE
ATLANTA GA
30341-4003
US

IV. Provider business mailing address

6435 FOX CREEK DR
CUMMING GA
30040-6692
US

V. Phone/Fax

Practice location:
  • Phone: 404-480-9330
  • Fax:
Mailing address:
  • Phone: 714-743-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4223
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10261
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: