Provider Demographics
NPI:1063551950
Name:MCNEILL, MARY LU (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LU
Last Name:MCNEILL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3605 BRASELTON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4666
Mailing Address - Country:US
Mailing Address - Phone:678-804-7430
Mailing Address - Fax:678-804-7418
Practice Address - Street 1:3605 BRASELTON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4666
Practice Address - Country:US
Practice Address - Phone:678-804-7430
Practice Address - Fax:678-804-7418
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-05-16
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Provider Licenses
StateLicense IDTaxonomies
GA38869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1063551950OtherUPIN C19231