Provider Demographics
NPI:1568262640
Name:MAYFIELD, KELLIE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:MAYFIELD
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 1:1853 BRANDYWINE ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-4927
Mailing Address - Country:US
Mailing Address - Phone:804-683-4449
Mailing Address - Fax:
Practice Address - Street 1:1853 BRANDYWINE ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4927
Practice Address - Country:US
Practice Address - Phone:804-683-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty