Provider Demographics
NPI:1023017555
Name:CALDWELL, CHARLES GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GORDON
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2803
Mailing Address - Country:US
Mailing Address - Phone:912-257-9884
Mailing Address - Fax:
Practice Address - Street 1:514 E BRYAN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2803
Practice Address - Country:US
Practice Address - Phone:912-257-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14488207X00000X
TXD9381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1323784-07Medicaid
NH30205632Medicaid
NHP00728660OtherRAILROAD NUMBER
TXC14081Medicare UPIN
TX8C0892Medicare ID - Type Unspecified
TX1323784-07Medicaid