Provider Demographics
NPI:1215956495
Name:THRASHER, KELLY BURTON (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BURTON
Last Name:THRASHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5885 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5512
Mailing Address - Country:US
Mailing Address - Phone:404-252-7526
Mailing Address - Fax:404-851-1709
Practice Address - Street 1:5885 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5512
Practice Address - Country:US
Practice Address - Phone:404-252-7526
Practice Address - Fax:404-851-1709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-05-29
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Provider Licenses
StateLicense IDTaxonomies
GA052491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI12256Medicare UPIN
GA11SCCXFMedicare PIN