Provider Demographics
NPI:1023293347
Name:LATHEM, KELLY MILLER (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MILLER
Last Name:LATHEM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:200 S ENOTA DR NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3473
Mailing Address - Country:US
Mailing Address - Phone:770-534-5255
Mailing Address - Fax:770-287-3871
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:SUITE 150
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-534-5255
Practice Address - Fax:770-287-3871
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2011-09-14
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Provider Licenses
StateLicense IDTaxonomies
GA002085208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics