Individual
KELLY MACKENZIE SAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
144 DEPOT ST, BUCHANAN, GA 30113-5216
(770) 646-5512
Mailing address
52 CEDAR CREEK DR, DALLAS, GA 30157-6609
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003946
GA
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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