Healthcare Provider Details

I. General information

NPI: 1558274126
Provider Name (Legal Business Name): KELLIE LYNN GANAN RESTREPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLIE LYNN GANAN

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PARK OF COMMERCE WAY STE 100
SAVANNAH GA
31405-1358
US

IV. Provider business mailing address

800 CHESTNUT ST
CHATTANOOGA TN
37402-2510
US

V. Phone/Fax

Practice location:
  • Phone: 800-844-1232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: