# MACMED LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417062613
- **Authorized official:** JUDY S RIVENBARK M.D. (OWNER)
- **Authorized official phone:** (850) 279-4917

## Contact information

- **Practice address:** 2927 DEMERE RD, ATTEN: DR ANDREW T MCRAE, ST SIMONS ISLAND, GA 31522-1620
- **Practice address phone:** (912) 638-1999
- **Mailing address:** 1606 REYNOLDS ST, BRUNSWICK, GA 31520-6731
- **Mailing address phone:** (850) 279-4917
- **Mailing address fax:** (850) 279-4917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | GA051731 | GA | — |
| 208D00000X | General Practice Physician | GA11411 | GA | Yes |
| 208M00000X | Hospitalist Physician | GA11411 | GA | — |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 08/29/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300034700A | — | GA |