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General NPI Number Information
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NPI Number | 1588179162
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Entity Type | Individual
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Provider Name | ANDRE JERMAINE MCALLISTER CSA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 3195 MARTHA CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-8145
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Country | US
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Telephone | 470-234-1117
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Fax | 470-410-4419
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Provider Business Mailing Address
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Address Line | 8486 CAMPBELLTON ST # 392
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1819
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Country | US
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Telephone | 470-234-1117
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Fax | 470-410-4419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 4854
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License Number State | GA
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