Provider Demographics
NPI:1184837288
Name:MCKAY, MARILYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYNNE
Middle Name:
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 THORNBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5123
Mailing Address - Country:US
Mailing Address - Phone:404-788-6968
Mailing Address - Fax:
Practice Address - Street 1:2801 THORNBRIAR RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-5123
Practice Address - Country:US
Practice Address - Phone:404-788-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-337207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ3328Medicaid
NMZ3328Medicaid