Provider Demographics
NPI:1134333446
Name:RAWLINS, KELLY AYCOCK (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:AYCOCK
Last Name:RAWLINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 SAXONY TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2235
Mailing Address - Country:US
Mailing Address - Phone:678-513-9023
Mailing Address - Fax:
Practice Address - Street 1:2024 POWERS FERRY RD SE
Practice Address - Street 2:SUITE 190
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5011
Practice Address - Country:US
Practice Address - Phone:770-953-6666
Practice Address - Fax:770-952-5842
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice