Healthcare Provider Details

I. General information

NPI: 1316046105
Provider Name (Legal Business Name): KELLY J. HULSEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PRIOR ST SE
GAINESVILLE GA
30501-3449
US

IV. Provider business mailing address

PO BOX 655
GAINESVILLE GA
30503-0655
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-1245
  • Fax: 770-536-7989
Mailing address:
  • Phone: 770-536-1245
  • Fax: 770-536-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: