Provider Demographics
NPI:1659522530
Name:O'KELLEY, HANNAH M (LD)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:M
Last Name:O'KELLEY
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CATOOSA CIR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8077
Mailing Address - Country:US
Mailing Address - Phone:706-935-2366
Mailing Address - Fax:706-965-2369
Practice Address - Street 1:145 CATOOSA CIR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8077
Practice Address - Country:US
Practice Address - Phone:706-935-2366
Practice Address - Fax:706-965-2369
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered