Healthcare Provider Details

I. General information

NPI: 1518719079
Provider Name (Legal Business Name): KENDALL MARIE CALLIHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

190 WHITLEY XING
ROCKMART GA
30153-1101
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5000
  • Fax:
Mailing address:
  • Phone: 770-356-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-NP295182
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN295182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: