Healthcare Provider Details

I. General information

NPI: 1083766315
Provider Name (Legal Business Name): KELLEY WAGES STARNES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD KAISER PERMANENTE GWINNETT MEDICAL CENTER
DULUTH GA
30096-4506
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6110
  • Fax: 404-252-6794
Mailing address:
  • Phone: 404-364-7070
  • Fax: 404-252-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN147515
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN147515CNM
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: