Provider Demographics
NPI:1689920456
Name:CALLAHAN, LINDA V (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:V
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8974
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:299 POST OAK RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3526
Practice Address - Country:US
Practice Address - Phone:706-861-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN 209133V00000X
GALD 206133V00000X
TNLPC/MHSP 2178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD 206OtherLICENSED DIETITIAN
389163OtherREGISTERED DIETITIAN
TNLDN 209OtherLICENSED DIETITIAN / NUTRITIONIST
TNLPC/MHSP 2178OtherLICENSED PROFESSIONAL COUNSELOR/ MENTAL HEALTH SERVICES PROVIDER