Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 049686 | GA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 049686 | GA |
NPI | 1033187703 |
---|---|
Provider Name | Dr. Sanders R Callaway |
First Address | Charlotte, NC 28263-3001 |
Second Address | Evans, GA 30809-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80565 | (02) | GA |