Provider Demographics
NPI:1295919694
Name:ADKINS, KELLY MARIE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:ADKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:HORNAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1686
Mailing Address - Country:US
Mailing Address - Phone:800-346-1181
Mailing Address - Fax:706-232-0156
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000817207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA757333564AMedicaid
GA52227961OtherBCBS
GA202I226024Medicare PIN