Healthcare Provider Details

I. General information

NPI: 1558742767
Provider Name (Legal Business Name): KALYANI ARUN PANDYA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FERRY RD SUITE 100
ATLANTA GA
30342-1619
US

IV. Provider business mailing address

975 JOHNSON FERRY RD STE 100
ATLANTA GA
30342-1618
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1311
  • Fax: 404-250-3388
Mailing address:
  • Phone: 404-256-1311
  • Fax: 404-250-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7671
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7671
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: