Provider Demographics
NPI:1851738348
Name:KIM, SHELLY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANNE
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-851-2300
Mailing Address - Fax:404-851-2357
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1699
Practice Address - Country:US
Practice Address - Phone:404-851-2300
Practice Address - Fax:404-874-1249
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2024-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA6867207R00000X
GA006867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine