Healthcare Provider Details

I. General information

NPI: 1962475582
Provider Name (Legal Business Name): KELLEY MARSHALL JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLEY WOODRUFF MARSHALL MD

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7795 LANDOWNE DR
ATLANTA GA
30350-1063
US

IV. Provider business mailing address

CHILDREN'S HEALTHCARE OF ATLANTA 2220 NORTH DRUID HILLS ROAD NE-DEPARTMENT OF RADIOLOGY
ATLANTA GA
30329
US

V. Phone/Fax

Practice location:
  • Phone: 770-730-8535
  • Fax: 770-730-8535
Mailing address:
  • Phone: 404-785-6532
  • Fax: 770-730-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number048372
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number48372
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: