Individual
MR. EUGENE WYNN KALLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 BOULEVARD SQ, D, WAYCROSS, GA 31501-8021
(912) 387-0445
(912) 226-3513
Mailing address
1701 BOULEVARD SQ, D, WAYCROSS, GA 31501-8021
(912) 387-0445
(912) 226-3513
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
027395
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000311638C
—
GA
05
—
000311638I
—
GA
Enumeration date
10/23/2006
Last updated
11/17/2014
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