Individual
DR. KELLY WALLACE HUGHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1243 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 855-8989
(706) 855-0321
Mailing address
1243 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 855-8989
(706) 855-0321
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012769
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100202
AVESIS MEDICAID
GA
05
—
374703901B
—
GA
Enumeration date
11/30/2006
Last updated
12/01/2016
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