Healthcare Provider Details

I. General information

NPI: 1861745580
Provider Name (Legal Business Name): NANCY EYVONNE CALLOWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 CANDLER RD
DECATUR GA
30032-6502
US

IV. Provider business mailing address

11440 VINEA WAY
HAMPTON GA
30228-6258
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2710
  • Fax:
Mailing address:
  • Phone: 404-345-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003668
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4043450701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: