Healthcare Provider Details

I. General information

NPI: 1851618748
Provider Name (Legal Business Name): MACON ORTHOPAEDICS & INTEGRATIVE SPORTS MEDICINE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHARTER BLVD SUITE 300
MACON GA
31210-4892
US

IV. Provider business mailing address

540 CHARTER BLVD SUITE 300
MACON GA
31210-4892
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-9701
  • Fax: 478-475-9902
Mailing address:
  • Phone: 478-475-9701
  • Fax: 478-475-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERINOR SILLAH
Title or Position: OWNER / PHYSICIAN
Credential: M.D.
Phone: 478-475-7901