Eugene Wynn Kallay, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

027395 Issued in GA

Practice address

1701 Boulevard SQ
D
Waycross, GA 31501-8021

Phone

(912) 387-0445

Fax

(912) 226-3513

NPI assigned

Oct 23, 2006

Last updated

Nov 17, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BICIBA/Endpoint/BICIBA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Georgia Pediatrics

  • Primary Care Clinic/Center
  • Waycross, GA
  • NPI 1457613192
  Authorized official Same address or phone
• Southeast Georgia Health Services, L.L.C.

  dba Memorial Satilla Health

  • Rural Acute Care Hospital
  • Waycross, GA
  • NPI 1922530468
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416182400000",
    "number": "1063595973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 BOULEVARD SQ",
            "address_2": "D",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018021",
            "telephone_number": "912-387-0445",
            "fax_number": "912-226-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 BOULEVARD SQ",
            "address_2": "D",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018021",
            "telephone_number": "912-387-0445",
            "fax_number": "912-226-3513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAY",
        "first_name": "EUGENE",
        "middle_name": "WYNN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2014-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "027395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000311638I",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000311638C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Tree Counseling Center, LLC
• Faith Elizabeth Joyner, PA-C
• Jubilee Family Practice, LLC
• Mary A Justyn, CRNA
• Dannette Kallay, M.D.
• Kathleen M. Kallman, D.C.
• Kandallu R Ramesh, MD, PC
• Mary Kilcoyne, FNP-C
• Emilie Ann King, FNP-C
• Donna Kirby, RN

• Pediatrics Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.