Healthcare Provider Details

I. General information

NPI: 1669521902
Provider Name (Legal Business Name): CENTRAL GEORGIA PULMONARY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 HEMLOCK ST STE 200
MACON GA
31201-4200
US

IV. Provider business mailing address

458 HEMLOCK ST STE 200
MACON GA
31201-4200
US

V. Phone/Fax

Practice location:
  • Phone: 478-744-2445
  • Fax: 478-744-0906
Mailing address:
  • Phone: 478-744-2445
  • Fax: 478-744-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number043061
License Number StateGA

VIII. Authorized Official

Name: CLAY W SPENCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-744-2445