Provider Demographics
NPI:1164905287
Name:MCCARD, KELLI (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:MCCARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 BICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-3826
Mailing Address - Country:US
Mailing Address - Phone:478-951-5842
Mailing Address - Fax:
Practice Address - Street 1:101 MAYO ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3695
Practice Address - Country:US
Practice Address - Phone:478-951-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012140124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist