Healthcare Provider Details

I. General information

NPI: 1053394957
Provider Name (Legal Business Name): THOMAS MICHAEL CALLAHAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N ELM STREET
GREENSBORO NC
27401
US

IV. Provider business mailing address

1309 N ELM STREET
GREENSBORO NC
27401
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-5400
  • Fax: 336-544-5401
Mailing address:
  • Phone: 336-544-5400
  • Fax: 336-544-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number79053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: