Provider Demographics
NPI:1447388574
Name:MACON PAIN CENTER, P.C.
Entity Type:Organization
Organization Name:MACON PAIN CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-476-9886
Mailing Address - Street 1:PO BOX 13483
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3483
Mailing Address - Country:US
Mailing Address - Phone:478-476-9886
Mailing Address - Fax:
Practice Address - Street 1:3356 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2328
Practice Address - Country:US
Practice Address - Phone:478-476-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011231261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00707319FMedicaid
GA00707319FMedicaid
GAD39754Medicare UPIN
GA111199ASCAMedicare ID - Type UnspecifiedMEDICARE NUMBER