Provider Demographics
NPI:1417986266
Name:MCCALL, GERARD A (MA)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:A
Last Name:MCCALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9458
Mailing Address - Country:US
Mailing Address - Phone:919-735-9146
Mailing Address - Fax:919-735-0582
Practice Address - Street 1:2707 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9458
Practice Address - Country:US
Practice Address - Phone:919-735-9146
Practice Address - Fax:919-735-0582
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1016231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131KJOtherBCBSNC
NC3404189Medicaid