MEDICARE: KELLY MICHELLE DAYTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4335	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215085733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MICHELLE DAYTON LPC

Provider Business Mailing Address
First Line	:	7328 LITANY COURT
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542
Country	:	US
Telephone Number	:	404-697-9070
Fax Number	:	404-378-2394

Provider Business Practice Location Address
First Line	:	5203 ATLANTA HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3334
Country	:	US
Telephone Number	:	404-069-7907
Fax Number	:	678-828-9944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/02/2017

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