Healthcare Provider Details

I. General information

NPI: 1467277129
Provider Name (Legal Business Name): BETSY M CALLOWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

305 EDGEMOND CIR
RINGGOLD GA
30736-5259
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax:
Mailing address:
  • Phone: 423-774-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number37691
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: