Gina Marie Callaway, LMT 17789

Primary specialty

SpecialistTaxonomy code 174400000X

License

LMT 17789 Issued in OR

Practice address

11501 SW Pacific Hwy Ste 100
Tigard, OR 97223-8649

Phone

(503) 862-7787

NPI assigned

Jan 17, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Gina Marie Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1053616441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11501 SW PACIFIC HWY STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238649",
            "telephone_number": "503-862-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11501 SW PACIFIC HWY STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238649",
            "telephone_number": "503-862-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLAWAY",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "credential": "LMT 17789",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-17",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "LMT 17789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "JOHNSON",
            "middle_name": "MARIE",
            "credential": "LMT 17789",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• La'Asia Cain
• Jordan Caines
• Dan Patrick Calabrese
• Christopher Alan Calawa, M.D.
• Tanzania Caldwell
• Lori Frances Callaway, R.N.
• Erin Claire Calvin
• Mary Elizabeth Cameron, LPC, LMFT
• Sheri Lyn Cameron, PA-C
• Kathrine Campanile, RN

• Specialist in Tigard, OR
• Providers in Tigard, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.