Healthcare Provider Details

I. General information

NPI: 1639296395
Provider Name (Legal Business Name): THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 PINE ST STE 100
MACON GA
31201-2107
US

IV. Provider business mailing address

764 PINE ST STE 100
MACON GA
31201-2107
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1145
  • Fax: 478-633-2849
Mailing address:
  • Phone: 478-633-1145
  • Fax: 478-633-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHRE002282
License Number StateGA

VIII. Authorized Official

Name: PHILIP WHEELER
Title or Position: CFO
Credential:
Phone: 706-509-3012