Healthcare Provider Details

I. General information

NPI: 1083756894
Provider Name (Legal Business Name): KELLY SOLMS GARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD # 22
AUSTELL GA
30106
US

IV. Provider business mailing address

3950 AUSTELL RD # 22
AUSTELL GA
30106-1121
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4022
  • Fax: 770-732-4023
Mailing address:
  • Phone: 770-732-4022
  • Fax: 770-732-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: