Provider Demographics
NPI:1083298384
Name:BROWN, MACKENZIE D
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1158
Mailing Address - Country:US
Mailing Address - Phone:740-593-7125
Mailing Address - Fax:740-594-7122
Practice Address - Street 1:142 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1746
Practice Address - Country:US
Practice Address - Phone:740-593-7125
Practice Address - Fax:740-594-7122
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator