Provider Demographics
NPI:1467980938
Name:MCCALL, DARRIUS JOHN (ACT)
Entity Type:Individual
Prefix:
First Name:DARRIUS
Middle Name:JOHN
Last Name:MCCALL
Suffix:
Gender:M
Credentials:ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WADE
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-7813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 W EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:GOODWELL
Practice Address - State:OK
Practice Address - Zip Code:73939-1500
Practice Address - Country:US
Practice Address - Phone:501-438-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program