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NPI Code Detail

MEDICARE: DR. KELLY MACKEY MD

MEDICARE:  DR. KELLY  MACKEY  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician047346GA

General Provider Information

NPI Number : 1225101371
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY MACKEY MD
Provider Business Mailing Address
First Line : PO BOX 742616
Second Line :
City : ATLANTA
State : GA
Zip : 30374-2616
Country : US
Telephone Number : 770-219-8420
Fax Number :
Provider Business Practice Location Address
First Line : 2578 HELEN HWY
Second Line :
City : CLEVELAND
State : GA
Zip : 30528-2848
Country : US
Telephone Number : 770-219-9260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 11/28/2022

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Directions to “ DR. KELLY MACKEY MD” Practice Location

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