Provider Demographics
NPI:1821051814
Name:DOPSON, KELLEY B (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:B
Last Name:DOPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-252-3898
Mailing Address - Fax:404-843-0719
Practice Address - Street 1:980 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 720
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-252-3898
Practice Address - Fax:404-843-0719
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025144207V00000X
GA25144207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29324OtherUPIN #
GA00618626AMedicaid
GA16BDFCX127575OtherMEDICARE #