Provider Demographics
NPI:1770136335
Name:MEJIA, KALLI Q (ND)
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:Q
Last Name:MEJIA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 RIVERLANDING CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2841
Mailing Address - Country:US
Mailing Address - Phone:678-480-2530
Mailing Address - Fax:
Practice Address - Street 1:1929 RIVERLANDING CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-2841
Practice Address - Country:US
Practice Address - Phone:678-870-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath