Provider Demographics
NPI:1902470164
Name:ALBRECHT, KELLY DAWN (MD, FRCSC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DAWN
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 3RD AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1968
Mailing Address - Country:US
Mailing Address - Phone:346-221-4250
Mailing Address - Fax:
Practice Address - Street 1:425 W 3RD AVE STE 340
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1968
Practice Address - Country:US
Practice Address - Phone:229-312-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2024-11-13
Deactivation Date:2023-03-23
Deactivation Code:
Reactivation Date:2023-05-03
Provider Licenses
StateLicense IDTaxonomies
GA98774207VM0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine