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General NPI Number Information
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NPI Number | 1043528268
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Entity Type | Organization
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Legal Business Name | MEDCARE PHYSICIANS OF CENTRAL GEORGIA, LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1040 FOUNDERS ROW STE A
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City | GREENSBORO
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State | GA
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Zip | 30642-5261
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Country | US
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Telephone | 706-453-2522
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Fax | 706-453-2523
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Provider Business Mailing Address
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Address Line | PO BOX 4867
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City | MACON
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State | GA
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Zip | 31208-4867
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Country | US
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Telephone | 706-453-2522
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Fax | 706-453-2523
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Authorized Official
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Title or Position | CFO
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Name | MR. ANTHONY ROBERTSON
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Credential |
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Telephone | 336-553-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State | GA
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