Provider Demographics
NPI:1235932633
Name:MCKENZIE, REGINALD B (CPS-AD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:B
Last Name:MCKENZIE
Suffix:
Gender:
Credentials:CPS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-0479
Mailing Address - Country:US
Mailing Address - Phone:404-289-0313
Mailing Address - Fax:404-289-0314
Practice Address - Street 1:1957 LAKESIDE PKWY STE 510
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5859
Practice Address - Country:US
Practice Address - Phone:678-289-0313
Practice Address - Fax:404-289-0314
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist