MEDICARE: GRAHAM A KELLAMS DMD

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	122300000X	Dentist	DN015699	GA
2	1223G0001X	General Practice Dentistry	DN015699	GA

General Provider Information

NPI Number	:	1346736931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAHAM A KELLAMS DMD

Provider Business Mailing Address
First Line	:	2655 DALLAS HWY SW STE 510
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-7520
Country	:	US
Telephone Number	:	770-422-8776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 DALLAS HWY SW STE 510
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-7520
Country	:	US
Telephone Number	:	707-422-8776
Fax Number	:

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

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	06/25/2020

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Directions to “ GRAHAM A KELLAMS DMD” Practice Location

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