Individual
KELLY DIANE MCCARLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1908 TARVER DR, BLAKELY, GA 39823-1540
(229) 308-0460
Mailing address
1908 TARVER DR, BLAKELY, GA 39823-1540
(229) 308-0460
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN219753
GA
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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