Healthcare Provider Details

I. General information

NPI: 1215085733
Provider Name (Legal Business Name): KELLY MICHELLE DAYTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MICHELLE PRICHARD

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 ATLANTA HWY
FLOWERY BRANCH GA
30542-3334
US

IV. Provider business mailing address

7328 LITANY COURT
FLOWERY BRANCH GA
30542
US

V. Phone/Fax

Practice location:
  • Phone: 404-069-7907
  • Fax: 678-828-9944
Mailing address:
  • Phone: 404-697-9070
  • Fax: 404-378-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4335
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: