Healthcare Provider Details

I. General information

NPI: 1386198455
Provider Name (Legal Business Name): JOHN ROYAL MACON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN ROYAL MACON JR. MD

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 DAWSON RD SUITE 2200
ALBANY GA
31707-2800
US

IV. Provider business mailing address

2336 DAWSON RD SUITE 2200
ALBANY GA
31707-2800
US

V. Phone/Fax

Practice location:
  • Phone: 404-754-6333
  • Fax:
Mailing address:
  • Phone: 404-754-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number075456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: