Individual
MACKENZIE LURENE MASHBURN GRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8954 HOSPITAL DR, DOUGLASVILLE, GA 30134-2272
(678) 640-5023
Mailing address
3316 HIGH NOONTIDE WAY NW, ACWORTH, GA 30101-6967
(678) 640-5023
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN191815
GA
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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