Healthcare Provider Details

I. General information

NPI: 1386500437
Provider Name (Legal Business Name): JENNIFER MCKAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 GRAYSON HWY APT 1121
GRAYSON GA
30017-1916
US

IV. Provider business mailing address

1525 GRAYSON HWY APT 1121
GRAYSON GA
30017-1916
US

V. Phone/Fax

Practice location:
  • Phone: 678-862-5972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: