MS. KAKETHIA S. MACK NURSE PRACTITIONER
NPI 1346748837
Nurse Practitioner - Family in Ellenwood, GA

Q: What is Kakethia Mack's NPI number?

The NPI number for Kakethia Mack is 1346748837. It was assigned to this individual provider in the NPPES registry on January 30, 2018.

Q: What is Kakethia Mack's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kakethia Mack was last updated on July 2, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 30, 2018

4124 BOSENBERRY WAY, ELLENWOOD, GA 30294(678) 463-6568(678) 463-6568 Get Directions Write a Review

NPPES record last updated: July 2, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Ms. Kakethia S. Mack Nurse Practitioner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. KAKETHIA S. MACK NURSE PRACTITIONER (NPI 1346748837) is an individual family provider in Ellenwood, Georgia, licensed in Georgia (RN154797) and active in the NPI registry since January 2018.

NPPES Registry Identity

NPI1346748837

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMS. KAKETHIA S. MACKCredential: NURSE PRACTITIONER

Location Address4124 BOSENBERRY WAYEllenwood, GA 30294

Mailing Address4124 Bosenberry WayEllenwood, GA 30294-4265 · (678) 463-6568

Phone(678) 463-6568

Fax(678) 463-6568

Sole ProprietorYes

Enumeration DateJanuary 30, 2018

Last NPPES UpdateJuly 2, 2018

✔ NPI 1346748837 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in GA · RN154797

4124 BOSENBERRY WAY, Ellenwood, GA 30294

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kakethia Mack's NPI number?

The NPI number for Kakethia Mack is 1346748837. It was assigned to this individual provider in the NPPES registry on January 30, 2018.

Where is Kakethia Mack located?

Kakethia Mack practices at 4124 Bosenberry Way, Ellenwood, GA 30294. The listed phone number is (678) 463-6568.

What is Kakethia Mack's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Kakethia Mack was last updated on July 2, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.