Provider Demographics
NPI:1588637011
Name:MCKENZIE, COLIN SEAWELL (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:SEAWELL
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9203
Mailing Address - Country:US
Mailing Address - Phone:706-653-8253
Mailing Address - Fax:706-653-9582
Practice Address - Street 1:100 SOUTHERN WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9203
Practice Address - Country:US
Practice Address - Phone:706-653-8253
Practice Address - Fax:706-653-9582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33392207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00441328AMedicaid
GA00441328AMedicaid
E61423Medicare UPIN