Provider Demographics
NPI:1639926058
Name:CALLOWAY, LARRY JASON
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JASON
Last Name:CALLOWAY
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 1:6255 TOWNCENTER DR STE 880
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9376
Mailing Address - Country:US
Mailing Address - Phone:336-909-9085
Mailing Address - Fax:336-712-0808
Practice Address - Street 1:6255 TOWNCENTER DR STE 880
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9376
Practice Address - Country:US
Practice Address - Phone:336-909-9085
Practice Address - Fax:336-712-0808
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula