Provider Demographics
NPI:1851618748
Name:MACON ORTHOPAEDICS & INTEGRATIVE SPORTS MEDICINE CENTER, PC
Entity Type:Organization
Organization Name:MACON ORTHOPAEDICS & INTEGRATIVE SPORTS MEDICINE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHERINOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-475-7901
Mailing Address - Street 1:540 CHARTER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4892
Mailing Address - Country:US
Mailing Address - Phone:478-475-9701
Mailing Address - Fax:478-475-9902
Practice Address - Street 1:540 CHARTER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4892
Practice Address - Country:US
Practice Address - Phone:478-475-9701
Practice Address - Fax:478-475-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty