Provider Demographics
NPI:1023194479
Name:CALLWOOD, DWAYNE DENNIS (MD)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:DENNIS
Last Name:CALLWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DWAYNE
Other - Middle Name:D
Other - Last Name:CALLWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1234 HUFFMAN MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-538-1234
Mailing Address - Fax:336-584-6811
Practice Address - Street 1:1234 HUFFMAN MILL ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-538-2374
Practice Address - Fax:336-584-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35857207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20860OtherBCBS
NC7116OtherPARTNERS
NC69723OtherMEDCOST
NC7920860Medicaid
NC7920860Medicaid
NC20860OtherBCBS