Individual
FELICIA M MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCA
Contact information
Practice address
307 KENDRICK ESTATES DR, JONESBORO, GA 30238-2196
(678) 758-2092
Mailing address
307 KENDRICK ESTATES DR, JONESBORO, GA 30238-2196
(678) 758-2092
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
NOT APPLICABLE
GA
Enumeration date
10/31/2017
Last updated
10/31/2017
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