Healthcare Provider Details

I. General information

NPI: 1609570670
Provider Name (Legal Business Name): MACKENZIE ROSE SOWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MEDICAL PARK
SMYRNA TN
37167-2843
US

IV. Provider business mailing address

810 MEDICAL PARK
SMYRNA TN
37167-2843
US

V. Phone/Fax

Practice location:
  • Phone: 615-223-5565
  • Fax:
Mailing address:
  • Phone: 615-223-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77520
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: