Provider Demographics
NPI:1437339785
Name:MACKEY, DOROTHEA KATRICE (PA)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:KATRICE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BORDERS WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8967
Mailing Address - Country:US
Mailing Address - Phone:478-352-0422
Mailing Address - Fax:888-813-6815
Practice Address - Street 1:104 BORDERS WAY STE 500
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-352-0422
Practice Address - Fax:888-813-6815
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant