Provider Demographics
NPI:1649363847
Name:FRANCKOWIAK, KELLY ANN (RD)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:FRANCKOWIAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:227 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5256
Mailing Address - Country:US
Mailing Address - Phone:770-720-7733
Mailing Address - Fax:770-704-7732
Practice Address - Street 1:2001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6442
Practice Address - Country:US
Practice Address - Phone:770-516-0552
Practice Address - Fax:770-516-0554
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002551133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000979756BMedicaid
GA000979756DMedicaid
GALD002551OtherSTATE LICENSE