1588179162 NPI number — MR. ANDRE JERMAINE MCALLISTER CSA

Table of content: MR. ANDRE JERMAINE MCALLISTER CSA (NPI 1588179162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588179162 NPI number — MR. ANDRE JERMAINE MCALLISTER CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCALLISTER
Provider First Name:
ANDRE
Provider Middle Name:
JERMAINE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588179162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8486 CAMPBELLTON ST # 392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30134-1819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-234-1117
Provider Business Mailing Address Fax Number:
470-410-4419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3195 MARTHA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30135-8145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-234-1117
Provider Business Practice Location Address Fax Number:
470-410-4419
Provider Enumeration Date:
12/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X , with the licence number: 4854 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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