Individual
DR. MINOR C VERNON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3951 RIDGE AVE, STE A, MACON, GA 31210-5050
(478) 475-1006
(478) 475-0787
Mailing address
3951 RIDGE AVE, STE A, MACON, GA 31210-5050
(478) 475-1006
(478) 475-0787
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
020359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00249213C
—
GA
01
—
1200048
UNITED HEALTHCARE NUMBER
GA
01
—
4417613
AETNA PPO NUMBER
GA
01
—
572632
BLUE CROSS BLUE SHIELD NO
GA
Enumeration date
08/16/2005
Last updated
07/09/2007
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