Healthcare Provider Details

I. General information

NPI: 1659348688
Provider Name (Legal Business Name): KELLEY E HUBBARD CRNA MBA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 315
ATLANTA GA
30327-2100
US

IV. Provider business mailing address

575 PROFESSIONAL DR STE 165
LAWRENCEVILLE GA
30046-3300
US

V. Phone/Fax

Practice location:
  • Phone: 888-408-0200
  • Fax:
Mailing address:
  • Phone: 770-277-3056
  • Fax: 855-204-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1183292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: