Healthcare Provider Details

I. General information

NPI: 1245146190
Provider Name (Legal Business Name): MARY ELIZABETH SOTO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 3RD ST STE 202
MACON GA
31201-3262
US

IV. Provider business mailing address

314 HOLLY DR
DUBLIN GA
31021-0404
US

V. Phone/Fax

Practice location:
  • Phone: 478-216-7378
  • Fax: 855-753-0046
Mailing address:
  • Phone: 478-353-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012844
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: