Healthcare Provider Details

I. General information

NPI: 1144964578
Provider Name (Legal Business Name): ONIKA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 CHEROKEE ST NE STE 100
MARIETTA GA
30060-8930
US

IV. Provider business mailing address

660 CHEROKEE ST NE STE 100
MARIETTA GA
30060-8930
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-8201
  • Fax:
Mailing address:
  • Phone: 678-797-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: