Provider Demographics
NPI:1912098773
Name:KALSON, MICHAEL JOEL (MD, FAAOS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:KALSON
Suffix:
Gender:M
Credentials:MD, FAAOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2440
Mailing Address - Country:US
Mailing Address - Phone:770-889-0891
Mailing Address - Fax:770-889-0354
Practice Address - Street 1:318 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2440
Practice Address - Country:US
Practice Address - Phone:770-889-0891
Practice Address - Fax:770-889-0354
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028421207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00328226AMedicaid
GA028421OtherLICENSE
GA20BBDNZMedicare ID - Type Unspecified
GA00328226AMedicaid