MEDICARE: DR. ALLISE M. CALLOWAY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	012709	GA

General Provider Information

NPI Number	:	1578541736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISE M. CALLOWAY DDS

Provider Business Mailing Address
First Line	:	4919 FLAT SHOALS PKWY
Second Line	:	SUITE 210
City	:	DECATUR
State	:	GA
Zip	:	30034-5258
Country	:	US
Telephone Number	:	678-418-3000
Fax Number	:	678-689-0371

Provider Business Practice Location Address
First Line	:	4919 FLAT SHOALS PKWY
Second Line	:	SUITE 210
City	:	DECATUR
State	:	GA
Zip	:	30034-5258
Country	:	US
Telephone Number	:	678-418-3000
Fax Number	:	678-689-0371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/08/2007

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