Healthcare Provider Details

I. General information

NPI: 1063564243
Provider Name (Legal Business Name): MICHAEL HARRIS CALLAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 LANIER PARK DR
GAINESVILLE GA
30501-2000
US

IV. Provider business mailing address

2406 LIGHTHOUSE MANOR DR
GAINESVILLE GA
30501-7401
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-5208
  • Fax: 770-534-8512
Mailing address:
  • Phone: 770-536-4352
  • Fax: 770-532-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number045050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: