Provider Demographics
NPI:1205654787
Name:MCCALLISTER, KERIN TAMARA (MS, CNS)
Entity type:Individual
Prefix:
First Name:KERIN
Middle Name:TAMARA
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4354
Mailing Address - Country:US
Mailing Address - Phone:678-787-3058
Mailing Address - Fax:
Practice Address - Street 1:2005 LAWRENCEVILLE SUWANEE RD STE 108
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2628
Practice Address - Country:US
Practice Address - Phone:678-787-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist