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General NPI Number Information
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NPI Number | 1578432860
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Entity Type | Individual
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Provider Name | MCKENZIE GAYLE FRETWELL
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Gender | Female
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2600 CENTURY PKWY NE
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City | ATLANTA
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State | GA
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Zip | 30345-3125
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Country | US
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Telephone | 229-726-8102
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Fax |
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Provider Business Mailing Address
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Address Line | 163 WILLOW LAKE DR
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City | LEESBURG
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State | GA
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Zip | 31763-5386
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Country | US
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Telephone | 229-726-8102
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | GA
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