Provider Demographics
NPI:1760464549
Name:STAHL, KELLEY A (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:A
Last Name:STAHL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:407 E MAPLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2635
Mailing Address - Country:US
Mailing Address - Phone:770-888-6697
Mailing Address - Fax:770-888-6998
Practice Address - Street 1:407 E MAPLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2635
Practice Address - Country:US
Practice Address - Phone:770-888-6697
Practice Address - Fax:770-888-6998
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-04-30
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Provider Licenses
StateLicense IDTaxonomies
GA054257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH50435Medicare UPIN