Provider Demographics
NPI:1124655154
Name:TAYLOR, MACKENZIE (DO)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:GILLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 SISKIN PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1306
Mailing Address - Country:US
Mailing Address - Phone:423-803-2226
Mailing Address - Fax:423-803-2222
Practice Address - Street 1:1 SISKIN PLZ
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1306
Practice Address - Country:US
Practice Address - Phone:423-803-2226
Practice Address - Fax:423-803-2222
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN5785208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program