Provider Demographics
NPI:1134778939
Name:DAILEY, KAELI SURILLA
Entity type:Individual
Prefix:
First Name:KAELI
Middle Name:SURILLA
Last Name:DAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SHERMAN LN NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-4957
Mailing Address - Country:US
Mailing Address - Phone:678-982-3914
Mailing Address - Fax:
Practice Address - Street 1:1300 RIDENOUR BLVD NW STE 300
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4402
Practice Address - Country:US
Practice Address - Phone:770-702-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant