Provider Demographics
NPI:1992734834
Name:GREGORY J. MACKAY, M. D., P. C.
Entity type:Organization
Organization Name:GREGORY J. MACKAY, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:404-255-2975
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 870
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-255-2975
Mailing Address - Fax:404-255-2276
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 870
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-255-2975
Practice Address - Fax:404-255-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032241208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty