Active NPI
Kerryn Castellon, DO
- Optician
- Buford, GA
National Provider Identifier
1255818993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- LDO002538
- Practice address
- 55 Sudderth St
Buford, GA 30518-3335 - Phone
- (678) 458-5095
- NPI assigned
- Jul 25, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | GA | ||
| Optician | 156FX1800X | LDO002538 | GA | Primary |
Addresses
Primary practice location
55 Sudderth St
Buford, GA 30518-3335
Mailing address
55 Sudderth St
Buford, GA 30518-3335
Phone (678) 458-5095
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 824147685 | Medicaid | GA |
Other names 1
- Kerryn Castellon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDO002538 | GA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1255818993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 SUDDERTH ST",
"city": "BUFORD",
"state": "GA",
"postal_code": "305183335",
"telephone_number": "678-458-5095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 SUDDERTH ST",
"city": "BUFORD",
"state": "GA",
"postal_code": "305183335",
"telephone_number": "678-458-5095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASTELLON",
"first_name": "KERRYN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-25",
"last_updated": "2018-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "GA",
"license": null,
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "GA",
"license": "LDO002538",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "824147685",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KERRYN",
"last_name": "CASTELLON",
"credential": "DO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.