| Doctor Name: | LEE RICHERSON MACKIN |
| NPI Number: | 1235293804 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA-508 |
| Business Practice Address: | 550 Twin Cities Blvd Ste A Niceville, FL - 325781050 |
| Business Phone Number: | 8507291444 |
| Business Fax Number: | |
| Mailing Address: | 9099 Brookshire Loop, DAPHNE |
| State: | AL |
| Postal Code: | 365266227 |
| Phone Number: | 2516899987 |
| Fax Number: | |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 03/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA-508 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |