MEDICARE: SHARON MCKENZIE

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	253Z00000X	In Home Supportive Care Agency
2	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1710591425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MCKENZIE

Provider Business Mailing Address
First Line	:	2203 CUMBERLAND PKWY SE STE 3388
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4508
Country	:	US
Telephone Number	:	901-672-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 CUMBERLAND PKWY SE UNIT 401
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4513
Country	:	US
Telephone Number	:	901-672-5322
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/16/2020

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Directions to “ SHARON MCKENZIE ” Practice Location

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