Individual
TYWONA MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1607 BARRINGTON VW, STONE MOUNTAIN, GA 30087-1846
(678) 582-9317
Mailing address
1607 BARRINGTON VW, STONE MOUNTAIN, GA 30087-1846
(678) 582-9317
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002100838
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003258912A
—
GA
Enumeration date
04/09/2022
Last updated
04/09/2022
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