Provider Demographics
NPI:1952622441
Name:MACON FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:MACON FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-755-8400
Mailing Address - Street 1:2040 BOWMAN PARK
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5782
Mailing Address - Country:US
Mailing Address - Phone:478-755-8400
Mailing Address - Fax:478-755-1073
Practice Address - Street 1:2040 BOWMAN PARK
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5782
Practice Address - Country:US
Practice Address - Phone:478-755-8400
Practice Address - Fax:478-755-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G086868Medicare UPIN