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General NPI Number Information
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NPI Number | 1831221068
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Entity Type | Individual
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Provider Name | KELLY J. SHEA-MILLER PH. D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 2470 MOUNT ZION PKWY DEPARTMENT OF ENT
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City | JONESBORO
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State | GA
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Zip | 30236-2500
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Country | US
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Telephone | 770-603-3542
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Fax |
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Provider Business Mailing Address
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Address Line | 4563 HOLLISTON ROAD
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City | ATLANTA
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State | GA
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Zip | 30360
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Country | US
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Telephone | 770-454-8890
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD003458
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License Number State | GA
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