Provider Demographics
NPI:1912418955
Name:STONE, KELLY MCKENZIE (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MCKENZIE
Last Name:STONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 BROOK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7654
Mailing Address - Country:US
Mailing Address - Phone:678-595-4320
Mailing Address - Fax:
Practice Address - Street 1:4530 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5412
Practice Address - Country:US
Practice Address - Phone:770-271-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor