# MACON VASCULAR CARE, LLC

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

## Provider details

- **NPI number:** 1417381781
- **Authorized official:** LISA A MCNAMARA (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (239) 597-2010

## Contact information

- **Practice address:** 889 2ND ST, MACON, GA 31201-6862
- **Practice address phone:** (478) 254-9363
- **Mailing address:** 9140 CORSEA DEL FONTANA WAY, NAPLES, FL 34109-4397

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2013
- **Last updated:** 08/22/2013