Individual
DR. KENNETH DALE MACKNET JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
617 POTOMAC PL STE 402, SMYRNA, TN 37167-5657
(615) 462-7682
(615) 462-7684
Mailing address
625 BAKERS BRIDGE AVE STE 105-226, FRANKLIN, TN 37067-1613
(615) 462-7682
(615) 462-7684
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A63594
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A63594
CA
207NP0225X
Pediatric Dermatology Physician
A63594
CA
207NS0135X
Procedural Dermatology Physician
A63594
CA
Other
Enumeration date
09/28/2006
Last updated
11/04/2025
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