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General NPI Number Information
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NPI Number | 1396013322
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Entity Type | Organization
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Legal Business Name | MACKY ENTERPRISES P.C.
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 5380 PEACHTREE INDUSTRIAL BLVD STE 140
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City | NORCROSS
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State | GA
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Zip | 30071-4713
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Country | US
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Telephone | 770-446-1818
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Fax | 770-446-1808
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Provider Business Mailing Address
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Address Line | 5380 PEACHTREE INDUSTRIAL BLVD STE 140
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City | NORCROSS
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State | GA
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Zip | 30071-4713
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Country | US
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Telephone | 770-446-1818
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Fax | 770-446-1808
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELLON ANGELA MCALLISTER
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Credential | M.D.
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Telephone | 770-446-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 61299
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License Number State | GA
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