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THOMAS ALEXANDEER MACKEAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
FNPC

Contact information

Practice address
704 GIL HARBIN INDUSTRIAL BLVD, VALDOSTA, GA 31601-6513
(229) 242-9003
(229) 242-0490
Mailing address
PO BOX 889, LAKE PARK, GA 31636-0889
(229) 242-9003
(229) 242-0490

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN146046
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
618616123A
GA
Enumeration date
03/01/2006
Last updated
04/01/2015
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