Healthcare Provider Details

I. General information

NPI: 1033187703
Provider Name (Legal Business Name): SANDERS R CALLAWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 TOWN PARK LN
EVANS GA
30809-3481
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-7546
  • Fax: 706-922-9168
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number049686
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number049686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: