Provider Demographics
NPI:1245924547
Name:KELLY, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KELLY
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 1:4191 PLEASANT HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1411
Mailing Address - Country:US
Mailing Address - Phone:470-444-4194
Mailing Address - Fax:470-704-5011
Practice Address - Street 1:4191 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1411
Practice Address - Country:US
Practice Address - Phone:470-444-4194
Practice Address - Fax:470-704-5011
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health