Provider Demographics
NPI:1275635393
Name:HOWARD, KELLY D (AA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:HOWARD
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:D
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:706-650-0705
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:400 MALL BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4861
Practice Address - Country:US
Practice Address - Phone:912-355-7214
Practice Address - Fax:517-787-7365
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004890367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA32BBCDPMedicare PIN