Provider Demographics
NPI:1326180720
Name:MCKAY, ANTONINA ZAIRE (DC)
Entity Type:Individual
Prefix:
First Name:ANTONINA
Middle Name:ZAIRE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2145
Mailing Address - Country:US
Mailing Address - Phone:770-252-3661
Mailing Address - Fax:770-252-9598
Practice Address - Street 1:2753 HIGHWAY 34 E
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2145
Practice Address - Country:US
Practice Address - Phone:770-252-3661
Practice Address - Fax:770-252-9598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA811896OtherBLUE CROSS BLUE SHIELD
GA44-00061OtherUNITEDHEALTH CARE
GAU81579Medicare UPIN
GA35ZCGCDMedicare ID - Type Unspecified