Individual
KILSY CUELLO PICHARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
157 CLINIC AVE STE 203, CARROLLTON, GA 30117-4454
(770) 832-0429
(770) 838-9108
Mailing address
157 CLINIC AVE, STE 203, CARROLLTON, GA 30117-4454
(770) 832-0429
(770) 838-9108
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
77453
GA
207RN0300X
Nephrology Physician
Primary
77453
GA
208D00000X
General Practice Physician
030553-R
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003164765B
—
GA
Enumeration date
04/09/2014
Last updated
06/17/2019
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