Individual
DR. CHARLES ALLEN CALLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH, O.D.
Contact information
Practice address
2120 HIGHWAY 76 STE A, COHUTTA PLACE, CHATSWORTH, GA 30705-7302
(706) 695-0107
(706) 517-9633
Mailing address
2120 HIGHWAY 76 STE A, COHUTTA PLACE PLAZA, CHATSWORTH, GA 30705-7302
(706) 695-0107
(706) 517-9633
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001074
GA
183500000X
Pharmacist
RPH012110
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000667664A
—
GA
01
—
1689833089
MEDICARE GROUP NPI
GA
01
—
511G700552
MEDICARE PROVIDER PTAN
GA
Enumeration date
02/09/2007
Last updated
06/05/2013
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