Provider Demographics
NPI:1932464377
Name:MEEKS, CALLIE CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:CARROLL
Last Name:MEEKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:MARIE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-1855
Mailing Address - Country:US
Mailing Address - Phone:843-235-1222
Mailing Address - Fax:843-314-4020
Practice Address - Street 1:38 BLACKGUM RD UNIT D
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8495
Practice Address - Country:US
Practice Address - Phone:843-235-1222
Practice Address - Fax:843-314-4020
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC349714Medicaid