Provider Demographics
NPI:1134769938
Name:MCKEE, MICAH (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:MCKEE
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GEESLIN RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8647
Mailing Address - Country:US
Mailing Address - Phone:601-513-1231
Mailing Address - Fax:601-513-1231
Practice Address - Street 1:416 GEESLIN RD
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-8647
Practice Address - Country:US
Practice Address - Phone:601-513-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT0894207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine