Individual
MRS. MARY C SIROR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
308 COLISEUM DR STE 120, MACON, GA 31217-3859
(478) 745-6130
(478) 745-4443
Mailing address
308 COLISEUM DR, MACON, GA 31217-3865
(478) 745-6130
(478) 745-4443
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN160662
GA
363LF0000X
Family Nurse Practitioner
RN160662
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003232245A
—
GA
01
—
G20164A
MEDICARE PTAN
GA
Enumeration date
11/07/2017
Last updated
10/13/2025
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