MEDICARE: KALLI PELAR COLEMAN ADDISON ATC/LAT, EMT-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146M00000X	Intermediate Emergency Medical Technician	I-40267	GA
2	2255A2300X	Athletic Trainer	AT002731	GA
3	363LF0000X	Family Nurse Practitioner	RN297931	GA

General Provider Information

NPI Number	:	1023566387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALLI PELAR COLEMAN ADDISON ATC/LAT, EMT-I

Provider Business Mailing Address
First Line	:	123 CHANDLER DR
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-6139
Country	:	US
Telephone Number	:	706-473-4497
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 CYPRESS LN
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-7567
Country	:	US
Telephone Number	:	706-473-4497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	12/11/2025

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