Provider Demographics
NPI:1265556948
Name:MCCALLIE, TAMMIE SMALL (DC)
Entity type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:SMALL
Last Name:MCCALLIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0008
Mailing Address - Country:US
Mailing Address - Phone:770-445-1362
Mailing Address - Fax:770-445-5860
Practice Address - Street 1:243 MERCHANTS DR.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0008
Practice Address - Country:US
Practice Address - Phone:770-445-1362
Practice Address - Fax:770-445-5860
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU88801Medicare UPIN