Provider Demographics
NPI:1316439870
Name:CALVIN, SAMELLA
Entity type:Individual
Prefix:
First Name:SAMELLA
Middle Name:
Last Name:CALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 ROYAL IVES CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2635
Mailing Address - Country:US
Mailing Address - Phone:678-477-2352
Mailing Address - Fax:678-477-2352
Practice Address - Street 1:1202 ROYAL IVES CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2635
Practice Address - Country:US
Practice Address - Phone:678-477-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherINSURANCE