Healthcare Provider Details

I. General information

NPI: 1821374828
Provider Name (Legal Business Name): KELLY KATHRYN THOMAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 OVER LAKE DR SE
CONYERS GA
30013-1745
US

IV. Provider business mailing address

2389 LITTLEBROOKE DR
DUNWOODY GA
30338-3187
US

V. Phone/Fax

Practice location:
  • Phone: 727-724-4227
  • Fax:
Mailing address:
  • Phone: 561-634-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1232055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: