| Doctor Name: | MRS. JACQUELINE KELLY CALDWELL |
| NPI Number: | 1992795439 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C, MPAS |
| License Number: | |
| Business Practice Address: | 1061 Harmon Ave Attn: Tfcmc Suite 1do3 Ft Stewart, GA - 313145604 |
| Business Phone Number: | 9124355595 |
| Business Fax Number: | |
| Mailing Address: | 60 Setter Ln, ALLENHURST |
| State: | GA |
| Postal Code: | 313012653 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |