Individual
MR. KELLY RAY ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2976 HIGHWAY 76, STE B&C, CHATSWORTH, GA 30705-6981
(706) 517-0656
(706) 517-0651
Mailing address
2976 HIGHWAY 76, STE B&C, CHATSWORTH, GA 30705-6981
(706) 517-0656
(706) 517-0651
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
977575
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777482691
—
GA
Enumeration date
06/14/2006
Last updated
05/11/2009
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