Provider Demographics
NPI:1093957334
Name:KELLEY, ROBERT STANISLAW (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STANISLAW
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5637 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-778-3401
Mailing Address - Fax:678-843-6501
Practice Address - Street 1:5637 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-778-3401
Practice Address - Fax:678-843-6501
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076096207VF0040X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program