Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 002427 | GA |
N | 207Q00000X | Family Doctor | 63674 | GA |
NPI | 1003013368 |
---|---|
Provider Name | Dr. Toya Hester Kelley |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 12/05/2010 |