Healthcare Provider Details

I. General information

NPI: 1336174499
Provider Name (Legal Business Name): KELLIE ANNE COYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PKWY
SANDY SPRINGS GA
30328-3431
US

IV. Provider business mailing address

2454 OAKLEIGH CT NE
ATLANTA GA
30345-3874
US

V. Phone/Fax

Practice location:
  • Phone: 404-299-6488
  • Fax: 404-299-7522
Mailing address:
  • Phone: 404-365-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number033060
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: