Healthcare Provider Details

I. General information

NPI: 1710890272
Provider Name (Legal Business Name): MACKENZIE BOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 TANNENHILL CT
SUGAR HILL GA
30518-7880
US

IV. Provider business mailing address

5102 TANNENHILL CT
SUGAR HILL GA
30518-7880
US

V. Phone/Fax

Practice location:
  • Phone: 678-446-7575
  • Fax: 678-446-7575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: