Basic Information
| Provider Information | |||||||||
| NPI: | 1235110891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WENDELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2564 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312032564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787465644 | ||||||||
| FaxNumber: | 4787454849 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 HOSPITAL DR. | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787465644 | ||||||||
| FaxNumber: | 4787454849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD27523 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 062398 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 214455199B | 05 | GA | MEDICAID | 214455199E | 05 | GA | MEDICAID | 566848 | 01 | GA | WELLCARE | OTHER | P00880783 | 01 | GA | RAILROAD MEDICARE | OTHER | 3890536 | 05 | TN | MEDICAID | 214455199D | 05 | GA | MEDICAID | 580628385 | 01 | GA | TRICARE | OTHER | 214455199C | 05 | GA | MEDICAID |