License Type Code = General
License Number = 1001008
Licensee Name = MACON GYNECOLOGIC ONCOLOGY, LLC
Business Name = MACON GYNECOLOGIC ONCOLOGY, LLC
Business Address Line1 = 380 HOSPITAL DRIVE, STE 460
Business Address Line2 =
Business Address Line3 =
Business City = MACON
Business State = GA
Business Zip = 31217
Primary Phone = (478) 845-7630
Contact Name = MICHAEL DILLON MD
License Status = Active
Start Of Business Date = 2015-12-22
Out Of Business Date =
Contractor = No
Application Date = 2015-12-22
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