Provider Demographics
NPI:1760824619
Name:KELLY, PAUL T (ARNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:KELLY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:T
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-6000
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-6000
Practice Address - Fax:770-219-6021
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226188363LF0000X
GARN260150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily