Healthcare Provider Details

I. General information

NPI: 1609988393
Provider Name (Legal Business Name): JOHN C CALLAHAN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 3RD ST
AURORA NC
27806-9088
US

IV. Provider business mailing address

151 3RD ST
AURORA NC
27806-9088
US

V. Phone/Fax

Practice location:
  • Phone: 252-322-4021
  • Fax: 252-322-5088
Mailing address:
  • Phone: 252-322-4021
  • Fax: 252-322-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9701709
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: