Healthcare Provider Details

I. General information

NPI: 1972298974
Provider Name (Legal Business Name): MACKENZIE SIMPKINS SHAMBLIN APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PIONEER DR
ATHENS GA
30605-4016
US

IV. Provider business mailing address

104 PIONEER DR
ATHENS GA
30605-4016
US

V. Phone/Fax

Practice location:
  • Phone: 706-466-6404
  • Fax:
Mailing address:
  • Phone: 706-466-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN280788
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27530
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: