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General NPI Number Information
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NPI Number | 1164440533
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Entity Type | Individual
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Provider Name | TIMOTHY CHARLES CASTELLAW PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 114 HARMONY XING STE 1
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City | EATONTON
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State | GA
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Zip | 31024-9546
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Country | US
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Telephone | 706-484-0884
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Fax | 706-484-0885
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Provider Business Mailing Address
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Address Line | 114 HARMONY XING STE 1
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City | EATONTON
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State | GA
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Zip | 31024-9546
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Country | US
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Telephone | 706-484-0884
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Fax | 706-484-0885
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1852
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License Number State | GA
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