Healthcare Provider Details

I. General information

NPI: 1588826051
Provider Name (Legal Business Name): MATTHEW C MCCALLISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OAK RIDGE TURNPIKE
OAK RIDGE TN
37830-6916
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-4088
  • Fax: 866-674-2033
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51426
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: