Healthcare Provider Details

I. General information

NPI: 1538755301
Provider Name (Legal Business Name): SHANA J MACKIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 N FRASER ST
GEORGETOWN SC
29440-6411
US

IV. Provider business mailing address

4731 HIGHWAY 17
MURRELLS INLET SC
29576-5127
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-3410
  • Fax: 843-527-6964
Mailing address:
  • Phone: 843-839-7246
  • Fax: 843-839-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24524
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: