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General NPI Number Information
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NPI Number | 1013312040
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Entity Type | Organization
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Legal Business Name | HEART OF GEORGIA RHEUMATOLOGY LLC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1508 HARDEMAN AVE STE A
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City | MACON
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State | GA
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Zip | 31201-1471
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Country | US
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Telephone | 478-742-3704
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Fax | 478-738-8609
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Provider Business Mailing Address
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Address Line | 1508 HARDEMAN AVE STE A
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City | MACON
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State | GA
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Zip | 31201-1471
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Country | US
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Telephone | 478-742-3704
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Fax | 478-738-8609
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Authorized Official
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Title or Position | FOUNDING MEMBER
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Name | DR. NANNETTE R CROWLEY
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Credential | MD
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Telephone | 478-742-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 052700
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License Number State | GA
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