Healthcare Provider Details

I. General information

NPI: 1386686491
Provider Name (Legal Business Name): GREGORY J MACKAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: GREGORY JAMES MACKAY

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 870
ATLANTA GA
30342
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD STE 870
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2975
  • Fax: 404-255-2276
Mailing address:
  • Phone: 404-255-2975
  • Fax: 404-255-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number032241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: