Individual
MYKEELA HACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2668 WARD LAKE RD, ELLENWOOD, GA 30294-1738
(678) 251-7560
Mailing address
2668 WARD LAKE RD, ELLENWOOD, GA 30294-1738
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
1246451
GA
Other
Enumeration date
05/18/2023
Last updated
07/10/2023
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