Provider Demographics
NPI:1790120509
Name:KAYSEN, KELLY ELYSE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELYSE
Last Name:KAYSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1365 CLIFTON ROAD NE BUILDING A
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-778-4366
Mailing Address - Fax:404-778-3217
Practice Address - Street 1:1365 CLIFTON ROAD NE BUILDING A
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-4366
Practice Address - Fax:404-778-3217
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA080529207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine