Provider Demographics
NPI: | 1467412205 |
---|---|
Name: | MCCALL, TERRY WAYNE (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TERRY |
Middle Name: | WAYNE |
Last Name: | MCCALL |
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: | PO BOX 1869 |
Mailing Address - Street 2: | |
Mailing Address - City: | FLETCHER |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28732-1869 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-687-5616 |
Mailing Address - Fax: | 828-650-8076 |
Practice Address - Street 1: | 100 HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSONVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28792 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-687-5662 |
Practice Address - Fax: | 828-650-6892 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-24 |
Last Update Date: | 2018-05-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 2005-01133 | 208M00000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 5601658 | Medicaid | |
NC | P00958829 | Other | MEDICARE RR |
7511834 | Other | AETNA | |
NC | 5601658 | Medicaid | |
NC | 2044020F | Medicare PIN |