Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1467919076 |
---|---|
Provider Name | Diamond Kelly |
First Address | Sandy Springs, GA 30328-5020 |
Second Address | Sandy Springs, GA 30328-5020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 01/03/2019 |