Provider Demographics
NPI:1265287247
Name:PARIS-SPURLOCK, KELLY (CNIM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PARIS-SPURLOCK
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26184 US HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:ALAPAHA
Mailing Address - State:GA
Mailing Address - Zip Code:31622-1324
Mailing Address - Country:US
Mailing Address - Phone:229-237-2789
Mailing Address - Fax:
Practice Address - Street 1:26184 US HIGHWAY 129
Practice Address - Street 2:
Practice Address - City:ALAPAHA
Practice Address - State:GA
Practice Address - Zip Code:31622-1324
Practice Address - Country:US
Practice Address - Phone:229-237-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2415246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic