Healthcare Provider Details

I. General information

NPI: 1548181704
Provider Name (Legal Business Name): GRAYSEN CAMILLE KELLEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MOUNT PARAN RD
SANDY SPRINGS GA
30327-4959
US

IV. Provider business mailing address

73 MOUNT PARAN RD
SANDY SPRINGS GA
30327-4959
US

V. Phone/Fax

Practice location:
  • Phone: 404-695-1220
  • Fax:
Mailing address:
  • Phone: 404-695-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026038637
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: