is a Specialist in Macon, Georgia. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1154373314. The last update date is .
's current location address is 890 2nd St, Macon, Georgia. You can contact this provider via phone number 4787454322 and fax number 4787508789. The mailing address for is 890 2nd St, Macon, Georgia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 890 2nd St, Macon, Georgia |
| Phone Number | 4787454322 |
| Fax Number | 4787508789 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1154373314 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 890 2nd St |
|---|---|
| City | Macon |
| State | Georgia (GA) |
| Post Code | 312016863 |
| Phone Number | 4787454322 |
| Fax Number | 4787508789 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 000867325I | GA | -- | |
| 000884606X | GA | -- | |
| 180599206M | GA | -- | |
| 770845851A | GA | -- | |
| 770845851C | GA | -- | |
| 000183598AN | GA | -- | |
| 000867325W | GA | -- | |
| 000884606AB | GA | -- | |
| 000884606D | GA | -- | |
| 000884606K | GA | -- |
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