Provider Demographics
NPI:1609049089
Name:HEMPHILL, KELLY EVERETT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EVERETT
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:LEIGH
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:655 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3756
Practice Address - Country:US
Practice Address - Phone:770-532-7092
Practice Address - Fax:770-536-0383
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5293363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA742533948BMedicaid
GA742533948AMedicaid
GA01357356OtherAMERIGROUP
GA587186OtherWELLCARE
GA742533948BMedicaid