Healthcare Provider Details

I. General information

NPI: 1073629630
Provider Name (Legal Business Name): MACON GYN/OB ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COLISEUM PL
MACON GA
31217-3867
US

IV. Provider business mailing address

650 COLISEUM PL
MACON GA
31217-3867
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-7935
  • Fax: 478-745-7806
Mailing address:
  • Phone: 478-745-7935
  • Fax: 478-745-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA

VIII. Authorized Official

Name: A T COPPAGE
Title or Position: PRESIDENT
Credential:
Phone: 478-745-7935