Healthcare Provider Details

I. General information

NPI: 1578354882
Provider Name (Legal Business Name): THE CORPORATION OF MERCER UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAZEL STREET
MACON GA
31201
US

IV. Provider business mailing address

1550 COLLEGE STREET MUSM DEAN'S SUITE
MACON GA
31207
US

V. Phone/Fax

Practice location:
  • Phone: 478-334-5050
  • Fax:
Mailing address:
  • Phone: 478-301-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES NETHERTON
Title or Position: EXEC. VICE PRESIDENT FOR ADMINSITRA
Credential:
Phone: 478-301-2710