Mack, Kakethia S.
Mack, Kakethia S. is an sole proprietor health care provider with primary practice located at 4124 Bosenberry Way , Ellenwood GA 30294. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Mack, Kakethia S. can be contacted via phone (678) 463-6568.Contact Information
Primary practice address
4124 Bosenberry Way
Ellenwood GA 30294
Phone: (678) 463-6568
Fax: (678) 463-6568
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | RN154797 | Georgia |
Profile Details
| NPI number | 1346748837 |
|---|---|
| LBN Legal business name | Mack, Kakethia S. |
| Credentials | NURSE PRACTITIONER |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 30th, 2018 |
| Last updated | Jul 2nd, 2018 - about 6 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.
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