=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639296395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 764 PINE ST STE 100
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-633-1145
-----------------------------------------------------
Fax | 478-633-2849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 764 PINE ST STE 100
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-633-1145
-----------------------------------------------------
Fax | 478-633-2849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | PHILIP WHEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-509-3012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | PHRE002282
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------