Organization
IM-PEDS PRIMARY CARE LLC
Active
Organization
IM-PEDS PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY EVELYN MCKINLEY MD (DOCTOR)
(478) 841-2707
Entity
Organization
Contact information
Practice address
360 HOSPITAL DR, BLDG D SUITE110, MACON, GA 31217-3874
(478) 841-2707
(478) 841-2708
Mailing address
360 HOSPITAL DR STE 110, MACON, GA 31217-8052
(478) 841-2707
(478) 841-2708
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
051256
GA
208000000X
Pediatrics Physician
051256
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954005A
—
GA
01
—
DF1259
RAILROAD MEDICARE
GA
Enumeration date
08/05/2006
Last updated
02/11/2019
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