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General NPI Number Information
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NPI Number | 1477582062
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Entity Type | Individual
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Provider Name | KELLEY W CARROLL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3031
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Country | US
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Telephone | 713-500-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 80 JESSE HILL JR DR SE P O BOX 26042
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City | ATLANTA
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State | GA
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Zip | 30303
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Country | US
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Telephone | 713-500-3500
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M1040
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License Number State | TX
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