Provider Demographics
NPI:1629748579
Name:CALLAHAN, ELIZABETH DAVIS (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DAVIS
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 WARE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-6101
Mailing Address - Country:US
Mailing Address - Phone:912-288-0783
Mailing Address - Fax:
Practice Address - Street 1:1910 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-7161
Practice Address - Country:US
Practice Address - Phone:912-285-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily