DR. KELLY WALLACE HUGHES (NPI# 1285702332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285702332 |
| Entity Type | Individual |
| Full Name | DR. KELLY WALLACE HUGHES |
| Other Name | DR. KELLY L WALLACE |
| Credential | DMD |
| Practice Address |
1243 Augusta West Pkwy Augusta GA 30909-1807 |
| Practice Telephone | 7068558989 |
| Practice Fax Number | 7068550321 |
| Mailing Telephone | 7068558989 |
| Mailing Fax Number | 7068550321 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2016-12-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN012769 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | AVESIS MEDICAID | 100202 | 01 |
| GA | 374703901B | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174174478 | Kelly Hughes | Licensed Practical Nurse | 2525 Montbello Cir, Kettering, OH 45440-2352 | 2019-09-27 |
| 1356626477 | Kelly Michelle Hughes | Social Worker | 2601 W 6th St Ste A, Lawrence, KS 66049-4319 | 2011-10-20 |
| 1811539729 | Kelly Hughes | Speech-Language Pathologist | 14016 Boydton Plank Rd, Dinwiddie, VA 23841-2500 | 2019-10-11 |
| 1396233318 | Kelly Eileen Hughes | Student in an Organized Health Care Education/Training Program | 833 Chestnut St Ste 220, Philadelphia, PA 19107-4405 | 2018-04-25 |
| 1164940045 | Kelly Danette Hughes | Occupational Therapist | 148 Stuart Nelson Park Rd, Paducah, KY 42001-9678 | 2017-08-31 |
| 1235677816 | Kelly Hughes | Licensed Practical Nurse | 3095 Kettering Blvd, Moraine, OH 45439-1983 | 2017-02-03 |
| 1023553112 | Kelly Hughes | Counselor | 300 Broadway Ave, Braselton, GA 30517 | 2016-12-27 |
| 1912370479 | Kelly L. Hughes | Counselor | 403 Stony Landing Rd, Moncks Corner, SC 29461-3967 | 2015-11-05 |
| 1295175354 | Kelly R Hughes | Behavioral Analyst | 1202 Morena Blvd, Suite 300, San Diego, CA 92110-3841 | 2013-07-03 |
| 1477860583 | Kelly Nicole Hughes | Physician Assistant | 200 Patewood Dr, Ste B400, Greenville, SC 29615-3593 | 2010-09-10 |
| Street Address |
1243 AUGUSTA WEST PKWY |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30909-1807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164490918 | Center for Pediatric Dentistry, PC | Dentist | 1243 Augusta West Pkwy, Augusta, GA 30909-1807 | 2006-03-09 |
| 1295935534 | Melissa Shaw | Dentist | 1243 Augusta West Pkwy, Augusta, GA 30909-1807 | 2007-07-24 |
| 1619936267 | Lee House Baker | Dentist | 1243 Augusta West Pkwy, Augusta, GA 30909-1807 | 2006-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912513888 | Lauran Simpson | Behavior Technician | 1237 Augusta West Parkway, Augusta, GA 30909 | 2020-09-16 |
| 1487273884 | Still Perspectives Counseling LLC | Counselor | 1265 Inerstate Prwy, Suite B, Augusta, GA 30909 | 2020-04-15 |
| 1598397838 | Mjra Medical LLC | Psychologist | 3675 J Dewey Gray Cr Ste 300, Augusta, GA 30909 | 2020-02-05 |
| 1003452319 | Danny Robinson | Counselor | 2609 Commons Boulevard, Augusta, GA 30909 | 2019-11-21 |
| 1407498637 | Candice M Cruse | Social Worker | 2609 Commons Blvd, Augusta, GA 30909 | 2019-10-09 |
| 1902363385 | Mary D Jodon | Pharmacist | 3338 Wrightsboro Rd., Augusta, GA 30909 | 2019-02-21 |
| 1447790514 | Burn Critical Care Associates, LLC | Internal Medicine | 3614 J. Dewey Gray Circle, Bldg B., Augusta, GA 30909 | 2017-03-08 |
| 1124561766 | Sasha Latara Mccraw | Counselor | 7303 Palomino Court, Augusta, GA 30909 | 2016-11-30 |
| 1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
| 1811358955 | Theodora Mcleskey | Nurse Practitioner | 1215 George C. Wilson Drive, Augusta, GA 30909 | 2016-03-17 |
| Find all providers in zip 30909 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497198154 | Brittany Rose Waters | Dentist | 2070 Reserve Ln, Augusta, GA 30907-6215 | 2013-04-12 |
| 1366708653 | June Murakaru | Dentist | 1120 15th St # Gc-2133, Augusta, GA 30912-0004 | 2012-04-11 |
| 1922188085 | Phillip Hickson Miller | Dentist | 104 Kings Chapel Rd, Augusta, GA 30907-4001 | 2006-10-16 |
| 1699873786 | I Gary Katcoff | Dentist | 3559 Wheeler Road, Augusta, GA 30909 | 2006-09-20 |
| 1306868872 | Michael Milano | Dentist | 1430 John Wesley Gilbert Drive Au Dental Associates, Augusta, GA 30912-7450 | 2006-07-24 |
| 1982644142 | Andrew Durbin Chandler | Dentist | 525 Pleasant Home Rd, Augusta, GA 30907-3525 | 2006-06-07 |
| 1164490918 | Center for Pediatric Dentistry, PC | Dentist | 1243 Augusta West Pkwy, Augusta, GA 30909-1807 | 2006-03-09 |
| 1245879006 | Pediatric Dental Associates of Atlanta | Dentist | 525 Pleasant Home Rd, Augusta, GA 30907-3525 | 2019-12-26 |
| 1801433750 | Mainely Kids & Teens, LLC | Dentist | 8 Shuman Ave, Augusta, ME 04330-7751 | 2019-12-10 |
| 1669815296 | Andrew Shoemaker | Dentist | 1430 John Wesley Gilbert Dr, Augusta, GA 30912-0001 | 2013-04-13 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.