Basic Information
| Provider Information | |||||||||
| NPI: | 1720492952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DWYER | ||||||||
| FirstName: | KELLEY | ||||||||
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| Credential: | AU.D. CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 LOCHWOLDE LN | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306203123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788637782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5455 MERIDIAN MARKS RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045911884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003971 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.