Provider Demographics
NPI:1114080520
Name:MCLARTY, WILLIAM THERON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:THERON
Last Name:MCLARTY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4015 SOUTH COBB DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-434-5100
Mailing Address - Fax:770-434-3923
Practice Address - Street 1:4015 SOUTH COBB DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-434-5100
Practice Address - Fax:770-434-3923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2017-04-25
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Provider Licenses
StateLicense IDTaxonomies
GA0132912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30191Medicare UPIN