Individual
KELLY SHADMAN PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1505 NORTHSIDE FORSYTH BLVD, STE 3500, CUMMING, GA 30041
(770) 292-6500
(770) 292-6535
Mailing address
3400 OLD MILTON PKWY # C, SUITE 290, ALPHARETTA, GA 30005-3707
(770) 667-4337
(770) 667-4338
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03244
NC
363A00000X
Physician Assistant
Primary
007088
GA
363A00000X
Physician Assistant
1512
TN
363AM0700X
Medical Physician Assistant
1512
TN
363AS0400X
Surgical Physician Assistant
PA0000001512
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003144287E
—
GA
05
—
003144287F
—
GA
05
—
003144287H
—
GA
Enumeration date
08/01/2007
Last updated
06/02/2020
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