Individual
KELLY DEOMELLAS LINDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
340 EISENHOWER DRIVE, SUITE 1200, SAVANNAH, GA 31406
(912) 443-4200
(912) 355-8124
Mailing address
210 EAST DERENNE AVENUE, SAVANNAH, GA 31405
(912) 644-5300
(912) 644-5260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005062
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005062
LICENSE
GA
01
—
1078016
NCCPA
GA
01
—
1553
TEMP PERMIT NUMBER
GA
Enumeration date
05/29/2007
Last updated
10/01/2014
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