Individual
MACKENZIE GRACE SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11700 MERCY BLVD, PLAZA D #6, SAVANNAH, GA 31419
(912) 927-3434
(912) 921-0982
Mailing address
836 E 65TH STREET, SUITE 20, SAVANNAH, GA 31405
(912) 819-7878
(912) 819-3555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8384
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003191402A
—
GA
Enumeration date
06/13/2017
Last updated
04/23/2019
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