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NPI Code Detail

MEDICARE: CAMMILLIA SHANNAE KELLY

MEDICARE: CAMMILLIA SHANNAE KELLY
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1538619861
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMMILLIA SHANNAE KELLY
Provider Business Mailing Address
First Line : 6200 BRADLEY PARK DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-3078
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6200 BRADLEY PARK DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-3078
Country : US
Telephone Number : 706-221-2024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2016
Last Update Date : 10/11/2016

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Directions to “ CAMMILLIA SHANNAE KELLY ” Practice Location

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