MEDICARE: ANDREW MCMILLIAN KELLERMANN DO

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	207R00000X	Internal Medicine Physician	2015-01644	NC

General Provider Information

NPI Number	:	1871756122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MCMILLIAN KELLERMANN DO

Provider Business Mailing Address
First Line	:	PO BOX 936857
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-6857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 S DICKINSON DR UNIT 230
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6434
Country	:	US
Telephone Number	:	910-662-6600
Fax Number	:	910-550-3787

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	03/18/2025

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