Healthcare Provider Details

I. General information

NPI: 1902881485
Provider Name (Legal Business Name): WILLIAM VAUGHN MCCALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 ST. SEBASTIAN WAY GEORGIA REGENTS MEDICAL ASSOCIATES
AUGUSTA GA
30901
US

IV. Provider business mailing address

1120 15TH ST STE BI1056
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6597
  • Fax: 706-721-6602
Mailing address:
  • Phone: 706-828-8401
  • Fax: 706-722-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number067733
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: