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General NPI Number Information
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NPI Number | 1558125179
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Entity Type | Individual
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Provider Name | JORDAN CHRISTOPHER CALLAIS
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Gender | Male
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 6 DOCTORS CIR STE 5
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City | SUPPLY
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State | NC
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Zip | 28462-6358
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Country | US
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Telephone | 910-721-4370
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Fax | 910-721-4379
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 803-800-8124
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15756
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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