Individual
DR. LARRY V. CALLOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
965 BATTLEFIELD PKWY, FORT OGLETHORPE, GA 30742-3945
(706) 866-8412
(706) 861-3354
Mailing address
965 BATTLEFIELD PKWY, FORT OGLETHORPE, GA 30742-3945
(706) 866-8412
(706) 861-3354
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN010304
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN010304
STATE LICENSE NUMBER
GA
01
—
DS0000004699
STATE LICENSE NUMBER
TN
Enumeration date
03/21/2007
Last updated
09/18/2012
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