Provider Demographics
NPI:1417635228
Name:CALHOUN, CANERICA DEMESHA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CANERICA
Middle Name:DEMESHA
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CANERICA
Other - Middle Name:DEMESHA
Other - Last Name:CALHOUN-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3371 DOGWOOD DR UNIT 140
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1488
Mailing Address - Country:US
Mailing Address - Phone:404-549-0060
Mailing Address - Fax:
Practice Address - Street 1:145 GREENCASTLE RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2937
Practice Address - Country:US
Practice Address - Phone:678-889-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner