Provider Demographics
NPI:1437312931
Name:SCHROTH, KELLEY STEPHENS (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:STEPHENS
Last Name:SCHROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ELIZABETH
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2408
Mailing Address - Country:US
Mailing Address - Phone:770-720-5100
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-303-3759
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080558A207R00000X, 208M00000X
GA071024208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146288AMedicaid
GA003146288AMedicaid