Provider Demographics
NPI:1649206715
Name:CALLAHAN, ALFRED SAMUEL III (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:SAMUEL
Last Name:CALLAHAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GLEN ECHO RD
Mailing Address - Street 2:STE 122
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2857
Mailing Address - Country:US
Mailing Address - Phone:615-297-5300
Mailing Address - Fax:615-297-5301
Practice Address - Street 1:2000 GLEN ECHO RD
Practice Address - Street 2:STE 122
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2857
Practice Address - Country:US
Practice Address - Phone:615-297-5300
Practice Address - Fax:615-297-5301
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0099332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3187893Medicaid
KY7024OtherMEDICARE
KY64772494OtherUNISYS
KY64772494OtherUNISYS
B59479Medicare UPIN