Mack, Candra Lanette

Mack, Candra Lanette is an individual health care provider with primary practice located at 4152 Baker Street, Ne , Covington GA 30014-1404. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Mack, Candra Lanette can be contacted via phone (770) 788-1077.

Contact Information

Primary practice address
4152 Baker Street, Ne Covington GA 30014-1404
Phone: (770) 788-1077
Fax: (770) 805-9329
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X TRN8908 Florida
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 61000 Georgia

Profile Details

NPI number 1487703153
LBN Legal business name Mack, Candra Lanette
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2007
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487703153 NPPES
Georgia Other 061000 MEDICAL LICENSE
Georgia MEDICAID 510091718A MEDICAL LICENSE

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