Individual provider · NPI-1

Dr. Phillip Justin Kelly

Student in an Organized Health Care Education/Training Program · Lithonia, GA

NPI number1598535619
StatusActive
Last updated in NPPESJan 9, 2024

Details

NPI
1598535619
Entity type
Individual (NPI-1)
Name
Dr. Phillip Justin Kelly
Sex
Male
Sole proprietor
No
Enumeration date
Jan 9, 2024
Certification date
Jan 9, 2024
Last updated
Jan 9, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
390200000X Student in an Organized Health Care Education/Training Program––Yes

Practice location

8075 Mall Pkwy Ste 103
Lithonia, GA 30038-6993

Phone 770-484-2955

Mailing address

714 Summit North Dr Ne
Atlanta, GA 30324-3144

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