Provider Demographics
NPI:1336373208
Name:MACON COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:MACON COUNTY MEDICAL CENTER
Other - Org Name:FLINT RIVER CLINIC AT REYNOLDS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-472-3246
Mailing Address - Street 1:509 SUMTER ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1733
Mailing Address - Country:US
Mailing Address - Phone:478-472-3246
Mailing Address - Fax:478-472-2412
Practice Address - Street 1:11 NORTH WINSTON STREET
Practice Address - Street 2:
Practice Address - City:REYNOLDS
Practice Address - State:GA
Practice Address - Zip Code:31076
Practice Address - Country:US
Practice Address - Phone:478-472-3246
Practice Address - Fax:478-472-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care