Provider Demographics
NPI:1083685051
Name:CALLAWAY, JANICE TUCK (MSW, PHD, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:TUCK
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:MSW, PHD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HANCOCK LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4741
Mailing Address - Country:US
Mailing Address - Phone:706-540-4128
Mailing Address - Fax:706-549-2887
Practice Address - Street 1:250 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2244
Practice Address - Country:US
Practice Address - Phone:706-583-2835
Practice Address - Fax:706-542-9714
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12111183500000X
GACSW0037571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No183500000XPharmacy Service ProvidersPharmacist