Healthcare Provider Details

I. General information

NPI: 1104621069
Provider Name (Legal Business Name): CALLIE JANE HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 02/15/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 LAWNDALE DR
GREENSBORO NC
27455-1889
US

IV. Provider business mailing address

1802 N HOLDEN RD
GREENSBORO NC
27408-3922
US

V. Phone/Fax

Practice location:
  • Phone: 336-235-4530
  • Fax:
Mailing address:
  • Phone: 336-254-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21962
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: