Basic Information
| Provider Information | |||||||||
| NPI: | 1083107502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYES | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MILLER | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CPNP-AC/PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 BRANDYWINE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303415540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1062 FORSYTH ST STE 3A | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312018640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2018 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN051783939 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0222X | RN235412 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care | 363LP0200X | RN235412 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.