Provider Demographics
NPI:1952403719
Name:BRUMMETT, KELLEY D (DMD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:D
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BAKER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2134
Mailing Address - Country:US
Mailing Address - Phone:770-251-8767
Mailing Address - Fax:770-251-7059
Practice Address - Street 1:404 GREEN ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3312
Practice Address - Country:US
Practice Address - Phone:770-536-1229
Practice Address - Fax:770-536-8773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO126611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice