Provider Demographics
NPI:1730652025
Name:MACON, URSULA ANDRESS
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:ANDRESS
Last Name:MACON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 MAEVE CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6567
Mailing Address - Country:US
Mailing Address - Phone:770-757-4929
Mailing Address - Fax:
Practice Address - Street 1:2772 MAEVE CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-6567
Practice Address - Country:US
Practice Address - Phone:770-757-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport