Provider Demographics
NPI:1457365686
Name:MCLEAN, TAMMY K (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 WHITTLESEY BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7334
Mailing Address - Country:US
Mailing Address - Phone:706-323-3491
Mailing Address - Fax:706-660-9191
Practice Address - Street 1:6600 WHITTLESEY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7334
Practice Address - Country:US
Practice Address - Phone:706-323-3491
Practice Address - Fax:706-660-9191
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053496207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA695051329AMedicaid
GAP01338529OtherRAILROAD MEDICARE
GA202I071208OtherMEDICARE PTAN
GA695051329CMedicaid
GAH97608Medicare UPIN
GA695051329CMedicaid