Provider Demographics
NPI:1669475760
Name:KALLAB, ANDRE M (MD)
Entity Type:Individual
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First Name:ANDRE
Middle Name:M
Last Name:KALLAB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3862
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:770-297-5034
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE 500
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-287-0031
Practice Address - Fax:770-297-5034
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-09-14
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Provider Licenses
StateLicense IDTaxonomies
GA45259207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44604Medicare UPIN