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General NPI Number Information
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NPI Number | 1851022578
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Entity Type | Individual
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Provider Name | ABRAHAM RENALDO BUTLER MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 420 CHARTER BLVD STE 402
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City | MACON
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State | GA
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Zip | 31210-0722
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Country | US
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Telephone | 478-757-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 420 CHARTER BLVD STE 402
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City | MACON
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State | GA
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Zip | 31210-0722
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 104257
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License Number State | GA
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