Provider Demographics
NPI:1336458827
Name:DR. JANA L MCKENZIE MD PC
Entity Type:Organization
Organization Name:DR. JANA L MCKENZIE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-769-3362
Mailing Address - Street 1:2410 HOG MOUNTAIN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4850
Mailing Address - Country:US
Mailing Address - Phone:706-769-3362
Mailing Address - Fax:706-769-5675
Practice Address - Street 1:2410 HOG MOUNTAIN RD STE 205
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4850
Practice Address - Country:US
Practice Address - Phone:706-769-3362
Practice Address - Fax:706-769-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty