Healthcare Provider Details

I. General information

NPI: 1376275743
Provider Name (Legal Business Name): DYMOND CALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OFFICE PARK CIR STE 306
MOUNTAIN BRK AL
35223-2692
US

IV. Provider business mailing address

4 OFFICE PARK CIR STE 306
MOUNTAIN BRK AL
35223-2692
US

V. Phone/Fax

Practice location:
  • Phone: 205-434-1424
  • Fax:
Mailing address:
  • Phone: 205-434-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2159
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: