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Individual

VICKY MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
694 ETHERIDGE MILL ROAD, ORCHARD HILL, GA 30266-0072
(770) 584-0837
Mailing address
PO BOX 72, ORCHARD HILL, GA 30266-0072
(770) 584-0837

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN066536
GA
363LG0600X
Gerontology Nurse Practitioner
RN066536
GA

Other

Enumeration date
11/02/2015
Last updated
11/02/2015
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