Provider Demographics
| NPI: | 1053481036 |
|---|---|
| Name: | MERCER MEDICINE, LLC |
| Entity Type: | Organization |
| Organization Name: | MERCER MEDICINE, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | WILLIAM |
| Authorized Official - Middle Name: | T |
| Authorized Official - Last Name: | BARNES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 478-301-4111 |
| Mailing Address - Street 1: | 1550 COLLEGE ST |
| Mailing Address - Street 2: | SUITE A |
| Mailing Address - City: | MACON |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 31207-1500 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 478-301-2362 |
| Mailing Address - Fax: | 478-301-2272 |
| Practice Address - Street 1: | 250 MARTIN LUTHER KING JR BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | MACON |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 31201 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 478-301-2362 |
| Practice Address - Fax: | 478-301-2272 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | THE CORPORATION OF MERCER UNIVERSITY |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-11-08 |
| Last Update Date: | 2014-03-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
