Provider Demographics
NPI:1356789192
Name:MIDDLETON, KELLIE KRISTIN (MD, MPH)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:KRISTIN
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3471 5TH AVE
Mailing Address - Street 2:1010
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3215
Mailing Address - Country:US
Mailing Address - Phone:770-362-5794
Mailing Address - Fax:
Practice Address - Street 1:771 OLD NORCROSS RD STE 105
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4977
Practice Address - Country:US
Practice Address - Phone:855-647-7678
Practice Address - Fax:404-847-4232
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204732207X00000X
GA84152207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery