Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 54304 | GA |
N | 207ND0900X | Dermatopathologist | 54304 | GA |
NPI | 1639202757 |
---|---|
Provider Name | Dr. Jamie B Mackelfresh |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |