Provider Demographics
NPI:1457595563
Name:CALLOWAY, EDGAR (NP)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 BELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6948
Mailing Address - Country:US
Mailing Address - Phone:205-426-3737
Mailing Address - Fax:205-477-0373
Practice Address - Street 1:4810 BELL HILL RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6948
Practice Address - Country:US
Practice Address - Phone:205-426-3737
Practice Address - Fax:205-477-0373
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-071194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner