=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255505509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD K MCKENZIE MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 TAZEWELL PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-689-7064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3301 TAZEWELL PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-689-7064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONALD KEITH MCKENZIE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 865-689-7064
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD9573
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------