Healthcare Provider Details

I. General information

NPI: 1750257226
Provider Name (Legal Business Name): CHATAVIA A CALLAWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD STE 333
BEVERLY HILLS CA
90212-3405
US

IV. Provider business mailing address

9100 WILSHIRE BLVD STE 333
BEVERLY HILLS CA
90212-3405
US

V. Phone/Fax

Practice location:
  • Phone: 720-574-7603
  • Fax: 855-582-8275
Mailing address:
  • Phone: 818-824-8770
  • Fax: 855-582-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: