Individual
AE MARY VILAYVONG IRWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
380 HOSPITAL DR STE 320, MACON, GA 31217-8007
(478) 750-8606
Mailing address
840 PINE ST STE 880, MACON, GA 31201-7525
(478) 743-7092
(478) 743-6293
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
RN110412
GA
363L00000X
Nurse Practitioner
Primary
RN145963
GA
Other
Enumeration date
07/16/2019
Last updated
11/29/2022
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