Individual
STACEY W MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2151 CENTURY LN, JOHNSON CITY, TN 37604-4469
(423) 926-2500
(423) 926-5999
Mailing address
PO BOX 70403, 365 STOUT DRIVE, JOHNSON CITY, TN 37614-1703
(423) 439-4515
(423) 439-5780
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
18756
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q010241
—
TN
Enumeration date
08/30/2005
Last updated
05/03/2017
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