Healthcare Provider Details

I. General information

NPI: 1366071557
Provider Name (Legal Business Name): KELLY A WINTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 404-785-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA239363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: