Healthcare Provider Details

I. General information

NPI: 1669432738
Provider Name (Legal Business Name): KELLIE KAY GEORGE A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E HAMILTON AVE
FLINT MI
48550-0001
US

IV. Provider business mailing address

6433 CRESTVIEW DR
HOLLY MI
48442-8437
US

V. Phone/Fax

Practice location:
  • Phone: 810-236-5198
  • Fax:
Mailing address:
  • Phone: 248-505-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: