Provider Demographics
NPI:1821386061
Name:CALLAWAY, MICHELLE ANNETTE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANNETTE
Other - Last Name:WINWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3104 CRANE MILL RD
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-2632
Mailing Address - Country:US
Mailing Address - Phone:774-292-9785
Mailing Address - Fax:470-201-1494
Practice Address - Street 1:3104 CRANE MILL RD
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:GA
Practice Address - Zip Code:30510-2632
Practice Address - Country:US
Practice Address - Phone:774-292-9785
Practice Address - Fax:470-201-1494
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator