Provider Demographics
NPI:1790010841
Name:MACKAY, NEIL S (PA-C)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:MACKAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3179
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:5955 STATE BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8208
Practice Address - Country:US
Practice Address - Phone:678-205-4261
Practice Address - Fax:678-417-7187
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GATEMP PERMIT 1961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant