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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