Provider Demographics
NPI:1164062550
Name:KELLINY, CAROLINE (PA)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:KELLINY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 BRIDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1067
Mailing Address - Country:US
Mailing Address - Phone:678-650-1298
Mailing Address - Fax:
Practice Address - Street 1:3770 BRIDLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1067
Practice Address - Country:US
Practice Address - Phone:678-650-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR615-PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine