Provider Demographics
NPI:1245635929
Name:SKINNER, CALLAWAY ANDERSON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CALLAWAY
Middle Name:ANDERSON
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CALLIE
Other - Middle Name:ANDERSON
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:120 S ZETTEROWER AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4816
Mailing Address - Country:US
Mailing Address - Phone:912-681-7368
Mailing Address - Fax:912-681-3687
Practice Address - Street 1:120 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4816
Practice Address - Country:US
Practice Address - Phone:912-681-7368
Practice Address - Fax:912-681-3687
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7433363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical