Provider Demographics
NPI:1831221068
Name:SHEA-MILLER, KELLY J (PH D)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:SHEA-MILLER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4563 HOLLISTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360
Mailing Address - Country:US
Mailing Address - Phone:770-454-8890
Mailing Address - Fax:
Practice Address - Street 1:2470 MOUNT ZION PKWY
Practice Address - Street 2:DEPARTMENT OF ENT
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:770-603-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003458231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist