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General NPI Number Information
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NPI Number | 1255107637
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Entity Type | Organization
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Legal Business Name | HEALTHYCONNECT OF MACON, LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 770 PINE ST STE 100
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City | MACON
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State | GA
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Zip | 31201-7565
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Country | US
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Telephone | 487-238-1092
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Fax | 478-841-9499
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Provider Business Mailing Address
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Address Line | 1880 LAKELAND DR STE E
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City | JACKSON
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State | MS
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Zip | 39216-4916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | WENDY HUGHES
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Credential |
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Telephone | 487-238-1092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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