Provider Demographics
NPI:1689826315
Name:MARIA CAVALIERE LLC
Entity Type:Organization
Organization Name:MARIA CAVALIERE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-746-0901
Mailing Address - Street 1:310 HOSPITAL DR BLDG B
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3895
Mailing Address - Country:US
Mailing Address - Phone:478-746-0901
Mailing Address - Fax:478-330-6150
Practice Address - Street 1:310 HOSPITAL DR BLDG B
Practice Address - Street 2:SUITE 300
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3895
Practice Address - Country:US
Practice Address - Phone:478-746-0901
Practice Address - Fax:478-330-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055662261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care