Provider Demographics
NPI:1619605458
Name:COMBS, CALLIE
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1078 ROBINSON TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CASSATT
Mailing Address - State:SC
Mailing Address - Zip Code:29032-9238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 ORCHARD GROVE LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9040
Practice Address - Country:US
Practice Address - Phone:513-280-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000Other000000000