Provider Demographics
NPI:1154025666
Name:MACKFIELD, BIANCA PATTERSON
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:PATTERSON
Last Name:MACKFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BIANCA
Other - Middle Name:SHEZERA
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1294 ALMONT DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-3770
Mailing Address - Country:US
Mailing Address - Phone:404-839-7934
Mailing Address - Fax:
Practice Address - Street 1:1294 ALMONT DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-3770
Practice Address - Country:US
Practice Address - Phone:404-839-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA81-1463454Medicaid