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Individual

KASSANDRA KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC, LAT

Contact information

Practice address
306B GRANADE ST, STATESBORO, GA 30458-2058
(912) 478-7582
Mailing address
PO BOX 8082, STATESBORO, GA 30460-1000

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001674
GA

Other

Enumeration date
01/13/2015
Last updated
01/13/2015
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