Individual
DR. KELLY HONSINGER NILSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2505 AIRPORT THRUWAY, COLUMBUS, GA 31904-9114
(706) 221-1122
Mailing address
320 STEELE CREEK DR, MIDLAND, GA 31820-4647
(601) 347-1725
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
842
MS
152W00000X
Optometrist
OPC004662
FL
152W00000X
Optometrist
Primary
OPT002997
GA
152W00000X
Optometrist
R-256-TA-B08
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002997
GEORGIA LICENSE NUMBER
GA
01
—
4662
FLORIDA LICENSE NUMBER
FL
01
—
842
MISSISSIPPI LICENSE NUMBER
MS
01
—
R256-TA-B08
ALABAMA LICENSE NUMBER
AL
Enumeration date
10/12/2011
Last updated
08/12/2021
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