Provider Demographics
NPI:1407676331
Name:CALLONAS, DAWSON BRIANNA
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:BRIANNA
Last Name:CALLONAS
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 1:993 N BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8927
Mailing Address - Country:US
Mailing Address - Phone:901-456-4546
Mailing Address - Fax:
Practice Address - Street 1:155 N STADIUM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4026
Practice Address - Country:US
Practice Address - Phone:479-575-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program