Healthcare Provider Details

I. General information

NPI: 1467480673
Provider Name (Legal Business Name): MICHAEL EUGENE CALLAHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD ATLANTA VA MEDICAL CENTER
DECATUR GA
30033-4004
US

IV. Provider business mailing address

3220 FRANCINE DR
DECATUR GA
30033-3358
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3240
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3240
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: