Provider Demographics
NPI:1043528268
Name:MEDCARE PHYSICIANS OF CENTRAL GEORGIA, LLC
Entity Type:Organization
Organization Name:MEDCARE PHYSICIANS OF CENTRAL GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-553-3322
Mailing Address - Street 1:PO BOX 4867
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4867
Mailing Address - Country:US
Mailing Address - Phone:706-453-2522
Mailing Address - Fax:706-453-2523
Practice Address - Street 1:1040 FOUNDERS ROW
Practice Address - Street 2:STE A
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5261
Practice Address - Country:US
Practice Address - Phone:706-453-2522
Practice Address - Fax:706-453-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty