Provider Demographics
NPI:1326048299
Name:KELSEY, RIBA (MD)
Entity Type:Individual
Prefix:
First Name:RIBA
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RIBA
Other - Middle Name:
Other - Last Name:KELSEY-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:HARRIS BLDG, 100-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-756-5764
Mailing Address - Fax:404-756-5252
Practice Address - Street 1:455 LEE ST SW FL 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1408
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:404-752-1191
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA558125872Medicaid
GA558125872Medicaid
H32639Medicare UPIN