Mack, Candra Lanette
Mack, Candra Lanette is an individual health care provider with primary practice located at 4152 Baker Street, Ne , Covington GA 30014-1404. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Mack, Candra Lanette can be contacted via phone (770) 788-1077.Contact Information
Primary practice address
4152 Baker Street, Ne
Covington GA 30014-1404
Phone: (770) 788-1077
Fax: (770) 805-9329
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | TRN8908 | Florida |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 61000 | Georgia |
Profile Details
| NPI number | 1487703153 |
|---|---|
| LBN Legal business name | Mack, Candra Lanette |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 10th, 2007 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487703153 | NPPES |
| Georgia | Other | 061000 | MEDICAL LICENSE |
| Georgia | MEDICAID | 510091718A | MEDICAL LICENSE |
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