Provider Demographics
NPI:1871850750
Name:GRAND PRAIRIE PROFESSIONAL GROUP, P. A.
Entity Type:Organization
Organization Name:GRAND PRAIRIE PROFESSIONAL GROUP, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-712-5862
Mailing Address - Street 1:200 POWELL PL
Mailing Address - Street 2:ATTN: LEGAL DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7514
Mailing Address - Country:US
Mailing Address - Phone:615-732-1605
Mailing Address - Fax:
Practice Address - Street 1:1171 107TH ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2502
Practice Address - Country:US
Practice Address - Phone:615-727-8387
Practice Address - Fax:615-457-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE19482084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty