Provider Demographics
NPI:1093805509
Name:KALMIN, BRUCE TERENCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TERENCE
Last Name:KALMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CUMMING HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8071
Mailing Address - Country:US
Mailing Address - Phone:678-593-1295
Mailing Address - Fax:678-593-1294
Practice Address - Street 1:2020 CUMMING HWY STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8071
Practice Address - Country:US
Practice Address - Phone:678-593-1295
Practice Address - Fax:678-593-1294
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I117290OtherMEDICARE PTAN
GA667854561GMedicaid