Individual
DR. KELLY WITHERS WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 LAKE HEARN DR STE 100, ATLANTA, GA 30342-1524
(404) 256-9809
Mailing address
1100 LAKE HEARN DR STE 100, ATLANTA, GA 30342-1524
(404) 256-9809
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125050671
IL
208000000X
Pediatrics Physician
65515
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65515
GEORGIA
GA
Enumeration date
07/31/2008
Last updated
12/10/2024
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