Provider Demographics
NPI:1588179162
Name:MCALLISTER, ANDRE JERMAINE (CSA)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:JERMAINE
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0938
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:4621 ARROW WIND DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5515
Practice Address - Country:US
Practice Address - Phone:470-234-1117
Practice Address - Fax:770-702-1919
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZC0007X
GA4854246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant