Provider Demographics
NPI:1154854792
Name:MCKEE, MAISON
Entity Type:Individual
Prefix:
First Name:MAISON
Middle Name:
Last Name:MCKEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GAMBEL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-6400
Mailing Address - Country:US
Mailing Address - Phone:850-445-4906
Mailing Address - Fax:
Practice Address - Street 1:2300A MANCHESTER EXPY STE 101B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6812
Practice Address - Country:US
Practice Address - Phone:706-256-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT111162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic