MEDICARE: ENTERPRISE FAMILY HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	040767	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP4689	OTHER	GA	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1760668586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERPRISE FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	2192 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2030
Country	:	US
Telephone Number	:	478-745-9880
Fax Number	:	478-745-8611

Provider Business Practice Location Address
First Line	:	2192 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2030
Country	:	US
Telephone Number	:	478-745-9880
Fax Number	:	478-745-8611

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DANA M HARRELSON
Credential	:
Telephone Number	:	478-745-9559

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

Similar Medicare Providers

1790521649 — MS. QUINTISIA BERETE KELLY
Practice Location Address:

2198 INGLESIDE AVE
MACON, GA
31204-2030

Practice Phone: 803-260-5807
Practice Fax:

1215911102 — DR. DARL WAYNE RANTZ M.D.
Practice Location Address:

2192 INGLESIDE AVE
MACON, GA
31204-2030

Practice Phone: 478-745-9880
Practice Fax: 478-745-8611

1508988270 — GEORGIA DEPT OF HUMAN RESOURCES
Practice Location Address:

2030 INGLESIDE AVE
MACON, GA
31204-2028

Practice Phone: 478-445-8182
Practice Fax:

1861894495 — ENTERPRISE FAMILY HEALTHCARE
Practice Location Address:

2192 INGLESIDE AVE
MACON, GA
31204-2030

Practice Phone: 478-745-9880
Practice Fax: 478-745-8611

1417481516 — CRYSTAL BALES FNP-C
Practice Location Address:

2192 INGLESIDE AVE
MACON, GA
31204-2030

Practice Phone: 478-336-5030
Practice Fax: 478-254-3146

1053975961 — ABC ANESTHESIA ASSOCIATES LLC
Practice Location Address:

2176 INGLESIDE AVE
MACON, GA
31204-2030

Practice Phone: 404-408-3100
Practice Fax:

Directions to “ENTERPRISE FAMILY HEALTHCARE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.