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Organization

MACMED LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUDY S RIVENBARK M.D. (OWNER)
(850) 279-4917
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300034700A
GA
Enumeration date
08/20/2006
Last updated
08/29/2012
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