Provider Demographics
NPI:1952679219
Name:CALLAWAY, DONALD WAYNE JR (ATP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:CALLAWAY
Suffix:JR
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-3422
Mailing Address - Country:US
Mailing Address - Phone:325-642-4765
Mailing Address - Fax:
Practice Address - Street 1:118 S PARK DR STE A
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5957
Practice Address - Country:US
Practice Address - Phone:325-643-3290
Practice Address - Fax:325-643-3295
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0107430247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other