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General NPI Number Information
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NPI Number | 1922199306
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Entity Type | Individual
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Provider Name | KENNETH DALE MACKNET JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 617 POTOMAC PL STE 402
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City | SMYRNA
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State | TN
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Zip | 37167-5657
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Country | US
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Telephone | 615-462-7682
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Fax | 615-462-7684
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Provider Business Mailing Address
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Address Line | 625 BAKERS BRIDGE AVE STE 105-226
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City | FRANKLIN
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State | TN
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Zip | 37067-1613
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Country | US
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Telephone | 615-462-7682
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Fax | 615-462-7684
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A63594
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | A63594
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | A63594
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A63594
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License Number State | CA
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