Healthcare Provider Details

I. General information

NPI: 1407032998
Provider Name (Legal Business Name): AMEETA SHIVDAS KALOKHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 06/18/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 JESSE HILL JR DR SE
ATLANTA GA
30303-3033
US

IV. Provider business mailing address

69 JESSE HILL JR DR SE
ATLANTA GA
30303-3033
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number68183
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number001450
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: