Provider Demographics
NPI:1033114962
Name:MCLEAN-JOSEPH, CARLA A (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:MCLEAN-JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 COUNTY SERVICES PKWY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4007
Mailing Address - Country:US
Mailing Address - Phone:770-528-4192
Mailing Address - Fax:770-528-5463
Practice Address - Street 1:1575 COUNTY SERVICES PKWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4007
Practice Address - Country:US
Practice Address - Phone:770-528-4192
Practice Address - Fax:770-528-5463
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000674781MMedicaid
GAF53747Medicare UPIN