Individual
MANUEL CARL MCKENZIE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4893 CANDLEWOOD LN, STONE MOUNTAIN, GA 30088-1605
(770) 896-1977
Mailing address
4893 CANDLEWOOD LN, STONE MOUNTAIN, GA 30088-1605
(770) 896-1977
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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