Provider Demographics
NPI:1518354554
Name:PELLETIER, KEVIN CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CONRAD
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-255-9325
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD STE G65
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1710
Practice Address - Country:US
Practice Address - Phone:404-843-3323
Practice Address - Fax:404-574-5944
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2022-10-20
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Provider Licenses
StateLicense IDTaxonomies
CAA148657208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation