Provider Demographics
NPI:1275357717
Name:MCCALLA, JULIAN A
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:A
Last Name:MCCALLA
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 1:2169 COLERIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2617
Mailing Address - Country:US
Mailing Address - Phone:901-562-8221
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 500B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5215
Practice Address - Country:US
Practice Address - Phone:901-683-6925
Practice Address - Fax:901-684-1435
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner