Individual
NICHOLAS KALLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
512 VILLAGE RD STE 101, SHALLOTTE, NC 28470-3409
(910) 721-4390
(910) 721-4399
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 721-4390
(910) 721-4399
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
0101231050
VA
207RP1001X
Pulmonary Disease Physician
Primary
9700305
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5857091
—
VA
Enumeration date
10/18/2005
Last updated
12/21/2023
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