Provider Demographics
NPI:1942658786
Name:SCHLEISMANN, KELLY (PDD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:SCHLEISMANN
Suffix:
Gender:F
Credentials:PDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EASTBROOK BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1568
Mailing Address - Country:US
Mailing Address - Phone:770-703-4726
Mailing Address - Fax:770-703-5052
Practice Address - Street 1:16 EASTBROOK BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1568
Practice Address - Country:US
Practice Address - Phone:770-703-4726
Practice Address - Fax:770-703-5052
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical