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MR. KELLY RAY ELLIOTT FNP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1497798532
Individual Registrant:MR. KELLY RAY ELLIOTT FNP
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
2976 HIGHWAY 76 STE B&C CHATSWORTH, GA 30705-6981 US
Tel: 706-517-0656 Fax: 706-517-0651
Tel: 706-517-0656 Fax: 706-517-0651
Contact information for business:
2976 HIGHWAY 76 STE B&C CHATSWORTH, GA 30705-6981 US
Tel: 706-517-0656 Fax: 706-517-0651
Tel: 706-517-0656 Fax: 706-517-0651
Registration Information:
NPI: 1497798532
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | GA | 977575 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 777482691 | GA | 05 |
