Provider Demographics
NPI:1447880943
Name:SEALES, CALLIE CARTER
Entity type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:CARTER
Last Name:SEALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CALLIE
Other - Middle Name:CARTER
Other - Last Name:WEAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 E MAGNOLIA AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:427 E MAGNOLIA AVE APT 27
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5575
Practice Address - Country:US
Practice Address - Phone:256-337-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12748390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program