Basic Information
| Provider Information | |||||||||
| NPI: | 1568670701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENNA | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | GARRETT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048887575 | ||||||||
| FaxNumber: | 4048857777 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 OAKSIDE LN | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301146417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785931295 | ||||||||
| FaxNumber: | 6785931294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2007 | ||||||||
| LastUpdateDate: | 11/15/2013 | ||||||||
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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 | 363A00000X | 002070 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.