Provider Demographics
NPI:1356497747
Name:MACON EYE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:MACON EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-741-6522
Mailing Address - Street 1:P.O. BOX 6908
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095
Mailing Address - Country:US
Mailing Address - Phone:478-741-1740
Mailing Address - Fax:478-745-2887
Practice Address - Street 1:864 1ST STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6875
Practice Address - Country:US
Practice Address - Phone:478-741-6522
Practice Address - Fax:478-745-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111305ASCAMedicare PIN