Healthcare Provider Details

I. General information

NPI: 1134197502
Provider Name (Legal Business Name): NANDOR A. KALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 TRIBBLE GAP RD
CUMMING GA
30040-2478
US

IV. Provider business mailing address

PO BOX 307
CUMMING GA
30028-0307
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-1668
  • Fax: 770-781-9937
Mailing address:
  • Phone: 770-887-1668
  • Fax: 770-887-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68040
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: