Provider Demographics
NPI:1730866591
Name:CHAMBERS, MACKENZIE HARRIS (AUD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:HARRIS
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 JOHNS CREEK PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1218
Mailing Address - Country:US
Mailing Address - Phone:770-814-1260
Mailing Address - Fax:
Practice Address - Street 1:4045 JOHNS CREEK PKWY STE B
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1218
Practice Address - Country:US
Practice Address - Phone:770-814-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004367231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist