Healthcare Provider Details

I. General information

NPI: 1609831056
Provider Name (Legal Business Name): CALLAWAY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 TUCKASEEGEE RD
CHARLOTTE NC
28208-2801
US

IV. Provider business mailing address

PO BOX 667967
CHARLOTTE NC
28266-7967
US

V. Phone/Fax

Practice location:
  • Phone: 704-395-0060
  • Fax: 704-521-5092
Mailing address:
  • Phone: 704-395-0060
  • Fax: 704-521-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLIFFORD K CALLAWAY
Title or Position: CEO
Credential: M.D., P.A.
Phone: 704-395-0060