Provider Demographics
NPI:1942828207
Name:CALHOUN, GERALD BENJAMIN II
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:BENJAMIN
Last Name:CALHOUN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7233
Mailing Address - Country:US
Mailing Address - Phone:229-977-4564
Mailing Address - Fax:
Practice Address - Street 1:50 DAVID RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5113
Practice Address - Country:US
Practice Address - Phone:850-997-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional