Provider Demographics
NPI:1972576320
Name:CALLENDER, CHARLES WYNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WYNTER
Last Name:CALLENDER
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 1:777 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2102
Mailing Address - Country:US
Mailing Address - Phone:478-633-6272
Mailing Address - Fax:478-633-6269
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-6272
Practice Address - Fax:478-633-6269
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069156207R00000X, 207RC0200X, 207RP1001X
VA0101231635207R00000X, 207RC0200X
GA69156207RP1001X
VA010231635207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA287179OtherANTHEM
VAPAROtherCORVEL/CORCARE
GA003131286MMedicaid
VAPAROtherMULTIPLAN
VA295660OtherUHC/MAMSI
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERICAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherAETNA
VAPAROtherCIGNA
NC89064T6Medicaid
VA-029OtherTRICARE/CHAMPUS
VA005862752Medicaid
NC046T6OtherBC/BS
VA42161OtherSENTARA OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA-029OtherTRICARE/CHAMPUS
VA005862752Medicaid