Provider Demographics
NPI:1386450443
Name:MCCLELLAN, LAILANI BAILON (FNP-C)
Entity type:Individual
Prefix:
First Name:LAILANI
Middle Name:BAILON
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 CONWAY CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4410
Mailing Address - Country:US
Mailing Address - Phone:229-588-9268
Mailing Address - Fax:
Practice Address - Street 1:202 W GORDON ST STE A
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4565
Practice Address - Country:US
Practice Address - Phone:229-474-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA138801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine