| Mac - Macon Road Llc | |
|
3465 Macon Rd Ste D Columbus GA 31907-2582 | |
| (706) 243-3051 | |
| Not Available |
| Full Name | Mac - Macon Road Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3465 Macon Rd Ste D, Columbus, Georgia |
| Authorized Official Name and Position | Robert O'neil Snoddy (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7062433051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mac - Macon Road Llc Po Box 84052 Columbus GA 31908-4052 Ph: (706) 243-0626 | Mac - Macon Road Llc 3465 Macon Rd Ste D Columbus GA 31907-2582 Ph: (706) 243-3051 |
| NPI Number | 1053599043 |
|---|---|
| Provider Enumeration Date | 02/01/2008 |
| Last Update Date | 10/07/2008 |
| Medicare PECOS PAC ID | 5799860151 |
|---|---|
| Medicare Enrollment ID | O20080310000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053599043 | NPI | - | NPPES |
| 934157678A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | James P Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598752560 PECOS PAC ID: 7416844410 Enrollment ID: I20040303000967 |
| Provider Name | Lisa M Plock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528056660 PECOS PAC ID: 8224094545 Enrollment ID: I20041208000077 |
| Provider Name | John S Womble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750379863 PECOS PAC ID: 2466418785 Enrollment ID: I20041208000125 |
| Provider Name | Eunice A Ampiaw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962499137 PECOS PAC ID: 1052496411 Enrollment ID: I20080905000483 |
| Provider Name | Suzanne M Mcbride |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881682144 PECOS PAC ID: 1153350277 Enrollment ID: I20090107000307 |
| Provider Name | Angie Renee Smith-haque |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124102405 PECOS PAC ID: 5092863282 Enrollment ID: I20090427000552 |
| Provider Name | Kamlesh G Ansingkar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184787327 PECOS PAC ID: 6608979554 Enrollment ID: I20100708000071 |
| Provider Name | Brandilyn K Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578878658 PECOS PAC ID: 8022294107 Enrollment ID: I20130808000572 |
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