MEDICARE: MS. ALFREDA LYNN MCKENZIE CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP006824	GA

General Provider Information

NPI Number	:	1093141475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALFREDA LYNN MCKENZIE CCC-SLP

Provider Business Mailing Address
First Line	:	1388 VILLAGE CREEK CIR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3281
Country	:	US
Telephone Number	:	470-210-4301
Fax Number	:	888-975-4313

Provider Business Practice Location Address
First Line	:	250 GEORGIA AVE SE STE 367
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3048
Country	:	US
Telephone Number	:	404-578-3000
Fax Number	:	888-975-4313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	01/13/2023

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Directions to “ MS. ALFREDA LYNN MCKENZIE CCC-SLP” Practice Location

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