Hughes, Kelly Wallace

Hughes, Kelly Wallace is an individual health care provider with primary practice located at 1243 Augusta West Pkwy , Augusta GA 30909-1807. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Hughes, Kelly Wallace can be contacted via phone (706) 855-8989.

Contact Information

Primary practice address
1243 Augusta West Pkwy Augusta GA 30909-1807
Phone: (706) 855-8989
Fax: (706) 855-0321
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X DN012769 Georgia

Profile Details

NPI number 1285702332
LBN Legal business name Hughes, Kelly Wallace
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2006
Last updated Dec 1st, 2016 - about 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285702332 NPPES
Georgia Other 100202 AVESIS MEDICAID
Georgia MEDICAID 374703901B AVESIS MEDICAID

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