Provider Demographics
NPI:1790213825
Name:CALLAWAY, DEVAN (DMD)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 SUGARLOAF RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4054
Mailing Address - Country:US
Mailing Address - Phone:706-436-7636
Mailing Address - Fax:
Practice Address - Street 1:3415 HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3354
Practice Address - Country:US
Practice Address - Phone:770-476-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0153941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice