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Macon Cardiovascular Institute

Organization Active NPI Surgery Physician · Macon, GA

NPI 1104866599 · NPPES record last updated Sep 11, 2025

Key facts

NPI
1104866599
Entity type
Organization (NPI type 2)
Primary specialty
Surgery Physician 208600000X
Legal business name
MACON CARDIOVASCULAR INSTITUTE
Practice address
575 1St St
Macon, GA 31201-2825
Phone
(478) 743-9762
Fax
(478) 746-6612
NPI assigned
Jun 7, 2006
Organization subpart
No

Authorized official

Name
Mrs. Lucy F Dermo
Title
Business Manager
Phone
(478) 743-9762

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 52

National Provider Directory

Locations

306 Corder Rd
Warner Robins, GA 31088
Phone (478) 293-4880

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X Yes
Vascular Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2086S0129X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208G00000X

Addresses

Primary practice location

575 1St St
Macon, GA 31201-2825

Mailing address

575 1St St
Macon, GA 31201-2825
Phone (478) 743-9762

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 11, 2025.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104866599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012825",
            "telephone_number": "478-743-9762",
            "fax_number": "478-746-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012825",
            "telephone_number": "478-743-9762",
            "fax_number": "478-746-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON CARDIOVASCULAR INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DERMO",
        "authorized_official_first_name": "LUCY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "478-743-9762",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

All providers in Macon, GA · Surgery Physician in Georgia

Sources for this page

Verify at the official NPI Registry.