Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Kakethia S. Mack, NURSEPRACTITIONER

Individual provider Family Nurse Practitioner · NPI 1346748837

MS. Kakethia S. Mack, NURSEPRACTITIONER is a Family Nurse Practitioner in Ellenwood, Georgia. Practices as a sole proprietor. Licensed in Georgia.

Licensed in
GA
In the registry since
2018

Practice location Address checks out

4124 Bosenberry Way
Ellenwood, GA 30294
Phone: (678) 463-6568
Fax: (678) 463-6568
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence RN154797 (GA)

Record details

NPI number1346748837
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedJanuary 30, 2018
Last updated in NPPESJuly 2, 2018

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