Healthcare Provider Details

I. General information

NPI: 1164372843
Provider Name (Legal Business Name): KELLY RENEE KARSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ENOTA DR NE STE 100
GAINESVILLE GA
30501-3466
US

IV. Provider business mailing address

15785 WESTBROOK RD
ALPHARETTA GA
30004-2891
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9000
  • Fax:
Mailing address:
  • Phone: 404-791-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP277682
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: