Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN173621 | GA |
N | 363LP2300X | Nurse Practitioner - Primary Care | RN173621 | GA |
NPI | 1013217645 |
---|---|
Provider Name | Lindsey C Mcclain |
First Address | Adel, GA 31620-6839 |
Second Address | Valdosta, GA 31602-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2010 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003127383A | (05) | GA |