Provider Demographics
NPI:1386686491
Name:MACKAY, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MACKAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:JAMES
Other - Last Name:MACKAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 870
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-255-2975
Mailing Address - Fax:404-255-2276
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 870
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-2975
Practice Address - Fax:404-255-2276
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032241208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5488425OtherAETNA
52674035002OtherBCBS
5488425OtherAETNA
GA24BCBSKMedicare ID - Type Unspecified