Healthcare Provider Details

I. General information

NPI: 1639202757
Provider Name (Legal Business Name): JAMIE B MACKELFRESH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

101 WOODRUFF CIR WMB RM 5034
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-0666
  • Fax:
Mailing address:
  • Phone: 404-727-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number54304
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number54304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: