Healthcare Provider Details

I. General information

NPI: 1316590151
Provider Name (Legal Business Name): ELIZABETH MCCANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 ROCKY CREEK RD UNIT A
MACON GA
31206-3581
US

IV. Provider business mailing address

2915 ROLLING RD
MACON GA
31204-1030
US

V. Phone/Fax

Practice location:
  • Phone: 478-461-4488
  • Fax:
Mailing address:
  • Phone: 478-461-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: