Provider Demographics
NPI:1992715270
Name:MCCALLA, AVIS CASSANDRA (CRNA)
Entity type:Individual
Prefix:MS
First Name:AVIS
Middle Name:CASSANDRA
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6455
Mailing Address - Country:US
Mailing Address - Phone:256-429-5071
Mailing Address - Fax:256-429-4674
Practice Address - Street 1:1 HOSPITAL DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6455
Practice Address - Country:US
Practice Address - Phone:256-429-5071
Practice Address - Fax:256-429-4674
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001105924367500000X
VA0024164487367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered