Provider Demographics
NPI:1316734759
Name:MOFFATT, KELLIE MARGARET
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:MARGARET
Last Name:MOFFATT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 EVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3783
Mailing Address - Country:US
Mailing Address - Phone:470-350-9708
Mailing Address - Fax:
Practice Address - Street 1:604 WASHINGTON ST NW STE A6
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8546
Practice Address - Country:US
Practice Address - Phone:770-531-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW012421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker