IndividualActive
Supriya Immaneni, MD
NPI 1497129399 · MOHS-Micrographic Surgery Physician · Macon, GA
Provider details
- NPI number
- 1497129399
- Entity type
- Individual
- Primary specialty
- MOHS-Micrographic Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- License
- 95284 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
308 Coliseum Dr
St 200
Macon, GA 31217-3865
Phone: (478) 742-2180
Approximate (ZIP-level) locationGet directions
Mailing address
308 Coliseum Dr
Macon, GA 31217-3865
Registry dates
- Enumerated
- 2015-11-17
- Last updated
- 2026-01-13
- Certified
- 2026-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.