Provider Demographics
NPI:1306923495
Name:MACON ELECTROPHYSIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:MACON ELECTROPHYSIOLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KINDLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-755-1560
Mailing Address - Street 1:639 HEMLOCK STR
Mailing Address - Street 2:STE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-755-1560
Mailing Address - Fax:478-755-1562
Practice Address - Street 1:639 HEMLOCK STR
Practice Address - Street 2:STE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-755-1560
Practice Address - Fax:478-755-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0001X
GA052807207RC0001X
GA061887207RC0001X
GA042444207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20330Medicare UPIN