Provider Demographics
NPI:1467285114
Name:CALVERT, JOHN MICAH
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICAH
Last Name:CALVERT
Suffix:
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 1:2093 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:AL
Mailing Address - Zip Code:35172-8560
Mailing Address - Country:US
Mailing Address - Phone:205-907-8656
Mailing Address - Fax:
Practice Address - Street 1:1595 CHURCH AVE SE APT 18A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3245
Practice Address - Country:US
Practice Address - Phone:205-907-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program