Basic Information
| Provider Information | |||||||||
| NPI: | 1669608501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCKENZIE CENTER FOR INTERNAL MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6031 SHALLOWFORD RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
| FaxNumber: | 4236484570 | ||||||||
| Practice Location | |||||||||
| Address1: | 6031 SHALLOWFORD RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
| FaxNumber: | 4236484570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 06/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCKENZIE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4236489808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.