Healthcare Provider Details

I. General information

NPI: 1447390901
Provider Name (Legal Business Name): CENTRAL GEORIGA FERTILITY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 ELNORA DR
MACON GA
31210-1822
US

IV. Provider business mailing address

598 3RD ST
MACON GA
31201-3357
US

V. Phone/Fax

Practice location:
  • Phone: 478-757-7888
  • Fax:
Mailing address:
  • Phone: 478-633-6706
  • Fax: 478-633-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CARNOVALE
Title or Position: PHYSICIAN
Credential: MD
Phone: 478-757-7888