Healthcare Provider Details

I. General information

NPI: 1154884807
Provider Name (Legal Business Name): KEELY IANNELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FY RD NE STE 350
ATLANTA GA
30342-4735
US

IV. Provider business mailing address

975 JOHNSON FY RD NE STE 350
ATLANTA GA
30342-4735
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2003
  • Fax: 404-785-3850
Mailing address:
  • Phone: 404-785-2003
  • Fax: 404-785-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number157664
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number100695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: