Provider Demographics
NPI:1063791424
Name:MCCALLUM, NIKIKI CATHERINE
Entity type:Individual
Prefix:MS
First Name:NIKIKI
Middle Name:CATHERINE
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 PIO NONO AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3536
Mailing Address - Country:US
Mailing Address - Phone:478-952-3180
Mailing Address - Fax:866-898-1099
Practice Address - Street 1:617 CRABAPPLE PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-5575
Practice Address - Country:US
Practice Address - Phone:478-952-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide