Provider Demographics
NPI:1558337055
Name:KELLY, JAMES BRIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:KELLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WHITE ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7901
Mailing Address - Country:US
Mailing Address - Phone:404-255-1933
Mailing Address - Fax:404-256-7924
Practice Address - Street 1:175 WHITE ST NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7901
Practice Address - Country:US
Practice Address - Phone:404-255-1933
Practice Address - Fax:404-256-7924
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical