Provider Demographics
NPI:1609876374
Name:CALTON, WILLIAM CUYLER JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CUYLER
Last Name:CALTON
Suffix:JR
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:225 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3050
Practice Address - Country:US
Practice Address - Phone:864-583-4420
Practice Address - Fax:864-560-4413
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215952086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
576000934-405OtherUNITED HEALTHCARE
NC89063N7Medicaid
2149912OtherFIRST HEALTH
SC5855667OtherAETNA
SCSCC4393365OtherMEDICARE PIN
SC197901OtherMEDCOST
SC215957Medicaid
SCF710715019OtherMEDICARE PIN
576000934-405OtherUNITED HEALTHCARE
F71071Medicare UPIN
NC89063N7Medicaid
SC020047245Medicare PIN