National Provider Identifier Database

MACON MEDICAL CLINIC LLC
Primary Care


Contact Information

MACON MEDICAL CLINIC, LLC.
3350 NORTHSIDE DR
MACON, GA31210-2504
Phone: 478-405-2121
Fax: 478-405-0114
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X
Health Service 261QH0100X
Medical Specialty 261QM2500X

* Indicates primary specialty

NPI Profile & details for MACON MEDICAL CLINIC, LLC.

NPI Number 1063823482
Legal business name
LBN
MACON MEDICAL CLINIC, LLC.
Authorized official MOHAMMAD RAHMAN - (PROVIDER/PHYSICIAN/OWNER)
Entity Organization
Organization subpart No
Enumeration date 05/20/2014
Last updated 05/20/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: 044065

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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