Provider Demographics
NPI:1316283252
Name:CALLADERM LLC
Entity type:Organization
Organization Name:CALLADERM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FAOCD
Authorized Official - Phone:423-408-1504
Mailing Address - Street 1:8 SHERIDAN SQ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7478
Mailing Address - Country:US
Mailing Address - Phone:423-408-1504
Mailing Address - Fax:
Practice Address - Street 1:8 SHERIDAN SQ
Practice Address - Street 2:SUITE 110
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7478
Practice Address - Country:US
Practice Address - Phone:423-408-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002262207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty