Provider Demographics
NPI:1386940419
Name:MACKY ENTERPRISES P.C.
Entity type:Organization
Organization Name:MACKY ENTERPRISES P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCALLISTER-BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-864-7788
Mailing Address - Street 1:5380 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4713
Mailing Address - Country:US
Mailing Address - Phone:770-864-7788
Mailing Address - Fax:770-446-1808
Practice Address - Street 1:5380 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 150
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4713
Practice Address - Country:US
Practice Address - Phone:770-864-7788
Practice Address - Fax:770-446-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61299208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty