Provider Demographics
NPI:1528752052
Name:CALHOUN, EBONI SHERELL (MS)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:SHERELL
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PRESERVATION PKWY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9859
Mailing Address - Country:US
Mailing Address - Phone:478-319-9722
Mailing Address - Fax:
Practice Address - Street 1:508 PRESERVATION PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9859
Practice Address - Country:US
Practice Address - Phone:478-319-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor