Healthcare Provider Details

I. General information

NPI: 1801537857
Provider Name (Legal Business Name): MAGGIE KATHLEEN MACKENZIE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TOWER RD NE STE 300
MARIETTA GA
30060-9408
US

IV. Provider business mailing address

9780 LOBLOLLY LN
ROSWELL GA
30075-4316
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-2457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03220321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: