Provider Demographics
NPI:1043397474
Name:MCKAY, JEREMY SEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SEAN
Last Name:MCKAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2234
Mailing Address - Country:US
Mailing Address - Phone:706-845-1601
Mailing Address - Fax:706-845-8510
Practice Address - Street 1:516 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2234
Practice Address - Country:US
Practice Address - Phone:706-845-1601
Practice Address - Fax:706-845-8510
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52048822OtherBCBS OF GA
GA103463OtherCENPATICO BEHAVIORAL HEAL