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General NPI Number Information
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NPI Number | 1841531068
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Entity Type | Organization
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Legal Business Name | KELLY PEDIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1913 DRUID OAKS NE
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City | ATLANTA
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State | GA
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Zip | 30329-3286
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Country | US
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Telephone | 404-323-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 DRUID OAKS NE
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City | ATLANTA
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State | GA
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Zip | 30329-3286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JANETTA M KELLY
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Credential | MD
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Telephone | 404-323-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 034169
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License Number State | GA
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