Basic Information
Provider Information
NPI: 1801822515
EntityType: 2
ReplacementNPI:  
OrganizationName: THE NEXUS MEDICAL GROUP, LLC
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Mailing Information
Address1: 777 HEMLOCK ST
Address2: MSC 159
City: MACON
State: GA
PostalCode: 312012102
CountryCode: US
TelephoneNumber: 4787428297
FaxNumber: 4787429670
Practice Location
Address1: 777 HEMLOCK ST
Address2:  
City: MACON
State: GA
PostalCode: 312012102
CountryCode: US
TelephoneNumber: 4787428297
FaxNumber: 4787429670
Other Information
ProviderEnumerationDate: 06/24/2006
LastUpdateDate: 06/11/2013
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AuthorizedOfficialLastName: WARD
AuthorizedOfficialFirstName: GENIE
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AuthorizedOfficialTitleorPosition: OFFICE MANAGER
AuthorizedOfficialTelephone: 4786332147
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
263110634A05GA MEDICAID


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