Mckissack, Dereka Mckissack
Mckissack, Dereka Mckissack is an sole proprietor health care provider with primary practice located at 374 N Deshon Rd Ste D , Stone Mountain GA 30087-4827. She recently has only one registered license in Dental Providers / Dental Assistant, which is considered as her primary health care specialty. Mckissack, Dereka Mckissack can be contacted via phone (770) 469-4192.Contact Information
Primary practice address
374 N Deshon Rd Ste D
Stone Mountain GA 30087-4827
Phone: (770) 469-4192
Fax: (770) 469-4195
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Assistant | 126800000X |
Profile Details
| NPI number | 1124469705 |
|---|---|
| LBN Legal business name | Mckissack, Dereka Mckissack |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 11th, 2013 |
| Last updated | Jul 11th, 2013 - about 12 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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