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General NPI Number Information
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NPI Number | 1396630794
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Entity Type | Individual
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Provider Name | CALYN KELLY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2035 FLAT SHOALS RD SE
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City | CONYERS
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State | GA
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Zip | 30013-1809
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Country | US
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Telephone | 770-992-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 BLOOM CIR
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City | TUCKER
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State | GA
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Zip | 30084-3313
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Country | US
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Telephone | 404-797-3859
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN268631
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License Number State | GA
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