CANDRA LANETTE MACK M.D. NPI 1487703153

NPI Information

NPI: 1487703153
Provider Name: CANDRA LANETTE MACK, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual
Address: 4152 BAKER STREET, NE
COVINGTON, GA
ZIP 30014
Phone: (770) 788-1077

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NPI Details

Candra Lanette Mack, M.D. is a pediatrics in Covington, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Candra Lanette Mack, M.D. NPI is 1487703153. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4152 BAKER STREET, NE
COVINGTON, GA
ZIP 30014-404
Phone: (770) 788-1077
Fax: (770) 805-9329

The enumeration date for this NPI number is 1/10/2007 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		TRN8908	FLORIDA	No
2	208000000X	Pediatrics		61000	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	061000	OTHER	GEORGIA	MEDICAL LICENSE
2	510091718A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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