Individual
ETHEL MAE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
229 S DAVIS RD STE 900, LAGRANGE, GA 30241-2609
(706) 756-1489
Mailing address
229 S DAVIS RD STE 900, LAGRANGE, GA 30241-2609
(706) 756-1489
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
RN3191402
FL
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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