Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT010287 | GA |
Y | 213ES0000X | Sports Medicine | PT010287 | GA |
NPI | 1104478643 |
---|---|
Provider Name | Kelli Michelle Dye Mclaren |
First Address | Alpharetta, GA 30004-2584 |
Second Address | Canton, GA 30115-8015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 15/07/2019 |