Provider Demographics
NPI:1396737946
Name:BALL, KELLY JONES (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JONES
Last Name:BALL
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BRASELTON HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5907
Mailing Address - Country:US
Mailing Address - Phone:678-377-9634
Mailing Address - Fax:678-377-9609
Practice Address - Street 1:3615 BRASELTON HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5907
Practice Address - Country:US
Practice Address - Phone:678-377-9634
Practice Address - Fax:678-377-9609
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004955235Z00000X
NC4664235Z00000X
AK33235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7411355OtherAETNA
GA306024Medicaid
GA10033353Medicaid
GA52006531-001OtherBLUE CROSS & BLUE SHIELD