Provider Demographics
NPI:1326070947
Name:NORMAN, KELLY P (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:P
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:PEACOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5104
Mailing Address - Country:US
Mailing Address - Phone:706-722-1381
Mailing Address - Fax:706-823-6871
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 4100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-722-1381
Practice Address - Fax:706-823-6871
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology