Healthcare Provider Details

I. General information

NPI: 1992638209
Provider Name (Legal Business Name): MACON KIDNEY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 GEORGIA AVE STE 2
MACON GA
31201-7610
US

IV. Provider business mailing address

1445 GEORGIA AVE STE 2
MACON GA
31201-7610
US

V. Phone/Fax

Practice location:
  • Phone: 478-250-1325
  • Fax: 478-254-6860
Mailing address:
  • Phone: 478-250-1325
  • Fax: 478-254-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN PRINCE
Title or Position: COMPLIANCE MANAGER
Credential:
Phone: 478-250-1325