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Organization
MIP MEDICAL MANAGEMENT
Active
Organization
MIP MEDICAL MANAGEMENT
Active
Other names
Macon Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA MARIE TATE CWCP (ADMINISTRATOR)
(478) 741-5901
Entity
Organization
Contact information
Practice address
833 WALNUT ST, MACON, GA 31201-2617
(478) 741-5901
(478) 741-5904
Mailing address
833 WALNUT ST, MACON, GA 31201-2617
(478) 741-5901
(478) 741-5904
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207R00000X
Internal Medicine Physician
45394335
GA
208VP0000X
Pain Medicine Physician
Primary
459343135
GA
Other
Enumeration date
01/06/2012
Last updated
02/14/2013
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