Provider Demographics
NPI:1801968755
Name:KELLY, PATRICIA ESTRELLA (MD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ESTRELLA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ESTRELLA
Other - Last Name:GOCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8534
Mailing Address - Fax:678-843-8501
Practice Address - Street 1:424 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1848
Practice Address - Country:US
Practice Address - Phone:678-843-8534
Practice Address - Fax:678-843-8501
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57435Medicare UPIN