Healthcare Provider Details

I. General information

NPI: 1255387544
Provider Name (Legal Business Name): TRINITY MCKENZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 MAIN STREET EAST
LIBERTY MS
39645-0514
US

IV. Provider business mailing address

5446 HIGHWAY 24
LIBERTY MS
39645-7237
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-8820
  • Fax: 601-657-9091
Mailing address:
  • Phone: 601-657-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19138
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19138
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: