Healthcare Provider Details

I. General information

NPI: 1982670345
Provider Name (Legal Business Name): JAMES HENRY MACKIE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BARRS ST 3RD FL
JACKSONVILLE FL
32204-4704
US

IV. Provider business mailing address

12133 CHEYENNE TRL
JACKSONVILLE FL
32223
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7741
  • Fax: 904-308-4095
Mailing address:
  • Phone: 904-292-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberAL180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: