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Individual

KELLIE TEDISCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
129 KELLY FARM DR, LUTHERSVILLE, GA 30251-1607
(770) 510-3520
Mailing address
129 KELLY FARM DR, LUTHERSVILLE, GA 30251-1607

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN231182
GA

Other

Enumeration date
09/05/2019
Last updated
09/05/2019
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