Provider Demographics
NPI:1235116880
Name:CALLAHAN, JOEL TRAVIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:TRAVIS
Last Name:CALLAHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3527
Mailing Address - Country:US
Mailing Address - Phone:828-694-4552
Mailing Address - Fax:
Practice Address - Street 1:2775 HENDERSONVILLE RD STE 250
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-0060
Practice Address - Country:US
Practice Address - Phone:828-435-8250
Practice Address - Fax:828-435-9251
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174382084N0400X
NC2011-000632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01079708OtherRR MEDICARE
MS00124984Medicaid
NCNC0953AOtherMEDICARE PTAN
NCNC0953AMedicare PIN
MS130000217Medicare PIN