Provider Demographics
NPI:1346897725
Name:WARREN, MACKENZIE (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 FLEUR DE LIS WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1203
Mailing Address - Country:US
Mailing Address - Phone:404-805-3294
Mailing Address - Fax:
Practice Address - Street 1:2753 FLEUR DE LIS WAY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-1203
Practice Address - Country:US
Practice Address - Phone:404-805-3294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222832163W00000X
GA222832363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse