Provider Demographics
NPI:1760247662
Name:PAUL, MACY E
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:E
Last Name:PAUL
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 1:395 WINDHAM BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDS
Mailing Address - State:GA
Mailing Address - Zip Code:31076-4008
Mailing Address - Country:US
Mailing Address - Phone:478-960-9804
Mailing Address - Fax:
Practice Address - Street 1:5300 BOWMAN PARK
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-6583
Practice Address - Country:US
Practice Address - Phone:478-741-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily