Organization
CARDIOVASCULAR ASSOCIATES OF MACON, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY P NOLLER (PRACTICE MANAGER)
(478) 743-5113
Entity
Organization
Contact information
Practice address
770 PINE ST, SUITE 480, MACON, GA 31201-2173
(478) 743-5113
Mailing address
770 PINE ST, SUITE 480, MACON, GA 31201-2173
(478) 743-5113
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
018170
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00196006A
—
GA
01
—
1720080443
PHYSICIAN NPI
GA
Enumeration date
12/13/2010
Last updated
12/13/2010
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