Provider Demographics
NPI:1992906598
Name:MAECENAS INC
Entity type:Organization
Organization Name:MAECENAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL CHAUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-894-5110
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-0146
Mailing Address - Country:US
Mailing Address - Phone:601-894-5110
Mailing Address - Fax:601-894-5154
Practice Address - Street 1:206 ROBERT MCDANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-0146
Practice Address - Country:US
Practice Address - Phone:601-894-5110
Practice Address - Fax:601-894-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015686Medicaid