Provider Demographics
NPI:1871756122
Name:KELLERMANN, ANDREW MCMILLIAN (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MCMILLIAN
Last Name:KELLERMANN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1333 S DICKINSON DR UNIT 230
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6434
Practice Address - Country:US
Practice Address - Phone:910-662-6600
Practice Address - Fax:910-550-3787
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01644207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871756122Medicaid
NC2015-01644OtherNC LICENSE
NC1871756122Medicaid