Provider Demographics
NPI:1437651924
Name:MCKENZIE, AMANDA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MANCHESTER LANE
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008
Mailing Address - Country:US
Mailing Address - Phone:478-396-2037
Mailing Address - Fax:
Practice Address - Street 1:5012 BRISTOL INDUSTRIAL WAY STE 110
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1775
Practice Address - Country:US
Practice Address - Phone:800-902-8800
Practice Address - Fax:844-641-3103
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily