Provider Demographics
NPI:1659310316
Name:MCCALL, CHARLES LOUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LOUIS
Last Name:MCCALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:791 WALNUT KNOLL LN
Mailing Address - Street 2:2ND FL
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8839
Mailing Address - Country:US
Mailing Address - Phone:901-755-7001
Mailing Address - Fax:901-753-2896
Practice Address - Street 1:367 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-661-2000
Practice Address - Fax:901-753-2896
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN156202085R0202X
KYTP3882085R0202X
KY497802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038448Medicaid
TNB00143Medicare UPIN
TN3038447Medicare ID - Type Unspecified