Provider Demographics
NPI:1972732162
Name:FAULKNER, KALLI KOLE (DO)
Entity type:Individual
Prefix:DR
First Name:KALLI
Middle Name:KOLE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KALLI
Other - Middle Name:KOLE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7694
Mailing Address - Country:US
Mailing Address - Phone:678-312-4526
Mailing Address - Fax:770-682-2219
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-4526
Practice Address - Fax:770-682-2219
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71935207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology