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General NPI Number Information
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NPI Number | 1083685051
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Entity Type | Individual
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Provider Name | JANICE TUCK CALLAWAY MSW, PHD, PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 250 NORTH AVE
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City | ATHENS
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State | GA
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Zip | 30601-2244
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Country | US
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Telephone | 706-583-2835
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Fax | 706-542-9714
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Provider Business Mailing Address
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Address Line | 265 HANCOCK LN
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City | ATHENS
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State | GA
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Zip | 30605-4741
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Country | US
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Telephone | 706-540-4128
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Fax | 706-549-2887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12111
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003757
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License Number State | GA
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