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General NPI Number Information
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NPI Number | 1164905287
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Entity Type | Individual
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Provider Name | KELLI MCCARD RDH
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 101 MAYO ST
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City | AMERICUS
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State | GA
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Zip | 31709-3695
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Country | US
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Telephone | 478-951-5842
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Fax |
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Provider Business Mailing Address
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Address Line | 672 BICKLEY RD
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City | BUTLER
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State | GA
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Zip | 31006-3826
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Country | US
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Telephone | 478-951-5842
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH012140
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License Number State | GA
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