Provider Demographics
NPI:1184955635
Name:TURNER, KELLY A (MA, LIC-A)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:TURNER
Suffix:
Gender:F
Credentials:MA, LIC-A
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:THISDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LIC-A
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-297-1780
Mailing Address - Fax:404-252-7255
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-297-1780
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003420231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101317HMedicaid
GA003101317IMedicaid
GA003101317FMedicaid
GA003101317FMedicaid