Healthcare Provider Details

I. General information

NPI: 1467407387
Provider Name (Legal Business Name): BRENT ALAN CALE, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 US HIGHWAY 280
AILEY GA
30410-3659
US

IV. Provider business mailing address

PO BOX 1645
AUGUSTA GA
30903-1645
US

V. Phone/Fax

Practice location:
  • Phone: 706-228-2535
  • Fax: 706-228-3433
Mailing address:
  • Phone: 706-228-2535
  • Fax: 706-228-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054256
License Number StateGA

VIII. Authorized Official

Name: BRENT ALAN CALE
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 706-228-2535