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General NPI Number Information
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NPI Number | 1154023679
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Entity Type | Individual
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Provider Name | ANGELA KELLAM
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 3766 US HIGHWAY 17 STE 203
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City | RICHMOND HILL
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State | GA
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Zip | 31324-8873
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Country | US
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Telephone | 706-364-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 WATERMARK DR
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City | COLUMBUS
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State | OH
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Zip | 43215-7088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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