Provider Demographics
NPI:1861903189
Name:MACON, MARGARET DUFFY (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:DUFFY
Last Name:MACON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 KENNESAW DUE WEST RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7640
Mailing Address - Country:US
Mailing Address - Phone:470-308-3365
Mailing Address - Fax:770-627-5228
Practice Address - Street 1:1595 KENNESAW DUE WEST RD NW STE 100
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7640
Practice Address - Country:US
Practice Address - Phone:470-308-3365
Practice Address - Fax:770-627-5228
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271936363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health