Healthcare Provider Details

I. General information

NPI: 1710591425
Provider Name (Legal Business Name): SHARON MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 CUMBERLAND PKWY SE UNIT 401
ATLANTA GA
30339-4513
US

IV. Provider business mailing address

2203 CUMBERLAND PKWY SE STE 3388
ATLANTA GA
30339-4508
US

V. Phone/Fax

Practice location:
  • Phone: 901-672-5322
  • Fax:
Mailing address:
  • Phone: 901-672-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: