Phillips, Kelly Shadman
Phillips, Kelly Shadman is an individual health care provider with primary practice located at 1505 Northside Forsyth Blvd Ste 3500, Cumming GA 30041. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Phillips, Kelly Shadman can be contacted via phone (770) 292-6500.Contact Information
Primary practice address
1505 Northside Forsyth Blvd Ste 3500
Cumming GA 30041
Phone: (770) 292-6500
Fax: (770) 292-6535
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 0010-03244 | North Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 1512 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 1512 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | PA0000001512 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 007088 | Georgia |
Profile Details
| NPI number | 1194915496 |
|---|---|
| LBN Legal business name | Phillips, Kelly Shadman |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 1st, 2007 |
| Last updated | Jun 2nd, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194915496 | NPPES |
| Georgia | MEDICAID | 003144287F | |
| Georgia | MEDICAID | 003144287H | |
| Georgia | MEDICAID | 003144287E |
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