Provider Demographics
NPI:1295829448
Name:MACKENZIE, CHRISTINE (ANP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2108
Mailing Address - Country:US
Mailing Address - Phone:770-973-7302
Mailing Address - Fax:770-971-6692
Practice Address - Street 1:1010 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2108
Practice Address - Country:US
Practice Address - Phone:770-973-7302
Practice Address - Fax:770-971-6692
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health