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NPI Code Detail

MEDICARE: MRS. KEISHA RENEE CALLINS M.D., M.P.H.

MEDICARE: MRS. KEISHA RENEE CALLINS M.D., M.P.H.
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
1207V00000XObstetrics & Gynecology Physician879908GA
2207V00000XObstetrics & Gynecology Physician065643GA

General Provider Information

NPI Number : 1164694089
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KEISHA RENEE CALLINS M.D., M.P.H.
Provider Business Mailing Address
First Line : 4292 GRAY HWY
Second Line :
City : GRAY
State : GA
Zip : 31032-5900
Country : US
Telephone Number : 478-301-2362
Fax Number : 478-301-2272
Provider Business Practice Location Address
First Line : 1550 COLLEGE ST
Second Line :
City : MACON
State : GA
Zip : 31207-1500
Country : US
Telephone Number : 478-301-2696
Fax Number : 478-301-2116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2008
Last Update Date : 10/31/2017

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