Provider Demographics
NPI:1619157997
Name:FAMILY HEALTH CARE OF MACON, P.C.
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF MACON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HUTCHINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-405-2222
Mailing Address - Street 1:3096 RIVERSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2545
Mailing Address - Country:US
Mailing Address - Phone:478-405-2222
Mailing Address - Fax:478-405-2229
Practice Address - Street 1:3096 RIVERSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2545
Practice Address - Country:US
Practice Address - Phone:478-405-2222
Practice Address - Fax:478-405-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1347OtherMEDICARE
GA00473888AMedicaid
GA034857Medicare PIN