Healthcare Provider Details

I. General information

NPI: 1700750312
Provider Name (Legal Business Name): ASHLEY JENNIFER KELLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

IV. Provider business mailing address

113 ARISTOCRATIC WAY
LOCUST GROVE GA
30248-2285
US

V. Phone/Fax

Practice location:
  • Phone: 678-688-2820
  • Fax: 440-467-9868
Mailing address:
  • Phone: 678-688-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN231749
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: