Healthcare Provider Details

I. General information

NPI: 1073447850
Provider Name (Legal Business Name): TEVFIK KALELIOGLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

IV. Provider business mailing address

1837 PRESERVATION CIR
EVANS GA
30809-0685
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number113614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: