Healthcare Provider Details

I. General information

NPI: 1275440513
Provider Name (Legal Business Name): KELLY CARE OASIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 REDA CT
MCDONOUGH GA
30253-1906
US

IV. Provider business mailing address

1445 WOODMONT LN NW STE 2635
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 470-851-6399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS KELLY
Title or Position: CEO
Credential:
Phone: 470-851-6399