Individual
MAKENZIE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3050
(913) 669-0877
Mailing address
33 BURGUNDY DR, LAKE SAINT LOUIS, MO 63367-1505
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
UNSURE
GA
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/10/2025
Last updated
02/06/2026
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