Organization
MACON MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUDWIG V. CAVALIERE MD (PHYSICIAN/CO-OWNER)
(478) 745-5455
Entity
Organization
Contact information
Practice address
640 MARTIN LUTHER KING JR BLVD, SUITE 200, MACON, GA 31201-3206
(478) 745-5455
(478) 745-2915
Mailing address
640 MARTIN LUTHER KING JR BLVD, SUITE 200, MACON, GA 31201-3206
(478) 745-5455
(478) 745-2915
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025393D
—
GA
05
—
300025393H
—
GA
01
—
CB5310
RXR MEDICARE
—
Enumeration date
08/02/2006
Last updated
05/04/2009
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