Provider Demographics
NPI:1700820651
Name:WHITE, KELLEY (MED,CCC-A)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3202
Mailing Address - Country:US
Mailing Address - Phone:478-743-8953
Mailing Address - Fax:478-743-1963
Practice Address - Street 1:540 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3202
Practice Address - Country:US
Practice Address - Phone:478-743-8953
Practice Address - Fax:478-743-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist