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General NPI Number Information
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NPI Number | 1710840269
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Entity Type | Individual
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Provider Name | LEAH MARIE KELLOGG
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 745 POPLAR RD
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City | NEWNAN
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State | GA
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Zip | 30265-1618
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Country | US
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Telephone | 770-400-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 398 MANN RD
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City | TYRONE
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State | GA
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Zip | 30290-1510
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Country | US
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Telephone | 678-877-4497
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN-NP306344
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License Number State | GA
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