Provider Demographics
NPI:1376150797
Name:GAMBLE, CALANDRA A (CMA)
Entity Type:Individual
Prefix:
First Name:CALANDRA
Middle Name:A
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 CRESCENT PKWY APT 406
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6044
Mailing Address - Country:US
Mailing Address - Phone:912-506-3226
Mailing Address - Fax:
Practice Address - Street 1:1115 MOUNT ZION RD STE 18A
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2275
Practice Address - Country:US
Practice Address - Phone:912-506-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health