Provider Demographics
NPI:1073111845
Name:GEORGE MACKEL, PMHNP-BC, LLC
Entity Type:Organization
Organization Name:GEORGE MACKEL, PMHNP-BC, LLC
Other - Org Name:OHANAPSYCH.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACKEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, PMHNP-BC
Authorized Official - Phone:808-777-9460
Mailing Address - Street 1:12034 BIG CANOE
Mailing Address - Street 2:400 SHETLAND TRACE
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:808-777-9460
Mailing Address - Fax:
Practice Address - Street 1:12034 BIG CANOE
Practice Address - Street 2:400 SHETLAND TRACE
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:808-777-9460
Practice Address - Fax:706-268-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty