Provider Demographics
NPI:1447458435
Name:MCKENZIE, MARY LAWLEY (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LAWLEY
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:W
Other - Last Name:LAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:320 E. MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408
Mailing Address - Country:US
Mailing Address - Phone:423-643-2246
Mailing Address - Fax:423-643-2030
Practice Address - Street 1:320 EAST MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408
Practice Address - Country:US
Practice Address - Phone:423-643-2246
Practice Address - Fax:423-643-2030
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA061807208D00000X
TN2777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice