Healthcare Provider Details

I. General information

NPI: 1740149780
Provider Name (Legal Business Name): KELLY BARNETTE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MILLARD FARMER IND BLVD STE A3
NEWNAN GA
30263-5821
US

IV. Provider business mailing address

417 DOC PERRY RD
NEWNAN GA
30263-3940
US

V. Phone/Fax

Practice location:
  • Phone: 678-877-7419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010470
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR010470
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: