Provider Demographics
NPI:1184227993
Name:MACKLIN, TISA
Entity Type:Individual
Prefix:
First Name:TISA
Middle Name:
Last Name:MACKLIN
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 1:2400 HERODIAN WAY SE STE 220
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8500
Mailing Address - Country:US
Mailing Address - Phone:404-827-8038
Mailing Address - Fax:
Practice Address - Street 1:2400 HERODIAN WAY SE STE 220
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8500
Practice Address - Country:US
Practice Address - Phone:404-827-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information