Individual
NICHOLAS OWEN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 CLAIREMONT AVE STE 190, DECATUR, GA 30030
(404) 748-9691
Mailing address
1875 CENTURY BLVD NE STE 150, ATLANTA, GA 30345-3323
(404) 633-4595
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35675
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356750
—
SC
Enumeration date
11/13/2009
Last updated
05/07/2019
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