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General NPI Number Information
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NPI Number | 1336608942
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Entity Type | Organization
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Legal Business Name | JACQUELYN MACEY PA-C LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 2400 WISTERIA DR STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-2689
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Country | US
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Telephone | 770-985-9330
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 TOWN BLVD NE UNIT 2302
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3662
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Country | US
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Telephone | 850-582-1221
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Fax |
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Authorized Official
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Title or Position | PHYSICAIAN ASSISTANT
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Name | JACQUELYN DENISE MACEY
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Credential | PA-C
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Telephone | 850-582-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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