Healthcare Provider Details

I. General information

NPI: 1972130102
Provider Name (Legal Business Name): CALEB ERIC ACKERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DR STE 360
LAWRENCEVILLE GA
30046-3370
US

IV. Provider business mailing address

631 PROFESSIONAL DR STE 360
LAWRENCEVILLE GA
30046-3370
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-2733
  • Fax:
Mailing address:
  • Phone: 678-312-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number114657
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: