Provider Demographics
NPI:1952370801
Name:WESELMAN, KELLY O'HARRA (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:O'HARRA
Last Name:WESELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 ATLANTA RD SE STE 315
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6443
Mailing Address - Country:US
Mailing Address - Phone:770-333-2035
Mailing Address - Fax:770-333-2059
Practice Address - Street 1:4441 ATLANTA RD SE STE 315
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-333-2035
Practice Address - Fax:770-333-2059
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047377207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000903944CMedicaid
GAP00890236OtherRAILROAD MEDICARE
GAP00890236OtherRAILROAD MEDICARE
GA000903944CMedicaid