Provider Demographics
NPI:1093809881
Name:MACKEY, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:STE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2440
Mailing Address - Country:US
Mailing Address - Phone:404-351-5045
Mailing Address - Fax:404-974-2196
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:STE 775
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-350-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP32313Medicare UPIN