Provider Demographics
NPI:1598198988
Name:COURTNEY, KELSEY GUERRESO (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:GUERRESO
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:GUERRESO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3157
Mailing Address - Country:US
Mailing Address - Phone:855-871-1526
Mailing Address - Fax:855-277-8543
Practice Address - Street 1:790 CHURCH ST NE STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8957
Practice Address - Country:US
Practice Address - Phone:678-626-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN608372085R0202X
GA931762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003270085MMedicaid