Provider Demographics
NPI:1346383189
Name:MONDI, KELLEY VELINDA (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:VELINDA
Last Name:MONDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:465 N. BELAIR ROAD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-854-2160
Mailing Address - Fax:706-854-2930
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-854-2160
Practice Address - Fax:706-854-2930
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA60939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB52260Medicare UPIN