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General NPI Number Information
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NPI Number | 1497431472
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Entity Type | Individual
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Provider Name | MACKENZIE HOPE BRACKETT-WISENER PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE STE 420
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City | MARIETTA
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State | GA
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Zip | 30060-1171
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Country | US
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Telephone | 770-514-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 55 WHITCHER ST NE STE 420
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City | MARIETTA
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State | GA
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Zip | 30060-1171
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Country | US
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Telephone | 770-514-6760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY900236
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License Number State | GA
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