Provider Demographics
NPI:1194238873
Name:PUCKETT, MACKENZIE ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ANTHONY
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2153
Mailing Address - Country:US
Mailing Address - Phone:706-543-5901
Mailing Address - Fax:
Practice Address - Street 1:335 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-543-5901
Practice Address - Fax:706-543-5901
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty