Provider Demographics
NPI:1922283159
Name:MCCALL, MEREDITH GRACE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:GRACE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 SW 20TH AVE APT 1005
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4448
Mailing Address - Country:US
Mailing Address - Phone:352-262-0373
Mailing Address - Fax:
Practice Address - Street 1:3643 SW 20TH AVE APT 1005
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4448
Practice Address - Country:US
Practice Address - Phone:352-262-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist