Healthcare Provider Details

I. General information

NPI: 1629583521
Provider Name (Legal Business Name): MICHAEL PAUL MCKINNEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

301 HIGHLAND POINTE DR
COHUTTA GA
30710-7348
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5478
  • Fax:
Mailing address:
  • Phone: 706-581-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9808
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0030039899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: