Healthcare Provider Details

I. General information

NPI: 1093809881
Provider Name (Legal Business Name): PATRICIA MACKEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1613
US

IV. Provider business mailing address

1720 PEACHTREE ST NW STE 200
ATLANTA GA
30309-2440
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1122
  • Fax:
Mailing address:
  • Phone: 404-351-5045
  • Fax: 404-974-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004498
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: