Provider Demographics
NPI:1578041737
Name:CALLIS, JAMES PAUL (MS, MPA, PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:CALLIS
Suffix:
Gender:M
Credentials:MS, MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 WILKINS DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6522
Mailing Address - Country:US
Mailing Address - Phone:904-891-8587
Mailing Address - Fax:
Practice Address - Street 1:155 KINGSLEY LN STE 320
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4629
Practice Address - Country:US
Practice Address - Phone:757-489-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-0063252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry