Provider Demographics
NPI:1972901759
Name:LOGAN, CALLIE (DNP FNP-C APRN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DNP FNP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 STONEHURST WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4951
Mailing Address - Country:US
Mailing Address - Phone:404-825-3127
Mailing Address - Fax:
Practice Address - Street 1:3715 NORTHSIDE PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2882
Practice Address - Country:US
Practice Address - Phone:404-825-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214237363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner