Mack Xpress Medical Diagnostics and Physicals

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

MACK XPRESS MEDICAL DIAGNOSTICS AND PHYSICALS

Doing business as

Mack Xpress Medical Diagnostics and Physicals

Practice address

45 Pine Grove Rd
Locust Grove, GA 30248-2561

Phone

(470) 507-4444

Fax

(470) 878-4788

NPI assigned

Jan 27, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kakethia S Mack, NP

Title

Owner

Phone

(678) 951-3794

Specialties & licenses 1

Addresses

Other names 1

• Mack Xpress Medical Diagnostics and Physicals Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1326754789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 PINE GROVE RD",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482561",
            "telephone_number": "470-507-4444",
            "fax_number": "470-878-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 PINE GROVE RD",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482561",
            "telephone_number": "470-507-4444",
            "fax_number": "470-878-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACK XPRESS MEDICAL DIAGNOSTICS AND PHYSICALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-27",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "KAKETHIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-951-3794",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mack Xpress Medical Diagnostics and Physicals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Locust Grove Pediatrics
• Jovan Antranatte Lovelace
• Camille Lundi, NP-C
• Luxottica of America Inc
• M&M Barkley LLC
• Macon Orthopaedic & Hand Center, PA
• Lori Magras, PT
• Shehnaz Makhani, MD
• Praya Mam, D.P.M.
• Vivekanand Manocha, M.D.

• Health Service Clinic/Center in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.