Provider Demographics
NPI:1144277088
Name:KELLY, LINDA SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUSAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1428 DUNWOODY VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-394-2358
Mailing Address - Fax:770-394-3055
Practice Address - Street 1:1428 DUNWOODY VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-394-2358
Practice Address - Fax:770-394-3055
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA047468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024308395AMedicaid
G59945Medicare UPIN
GAG59945Medicare UPIN