Provider Demographics
NPI:1336640044
Name:MCLEAN, JOHN TRACY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TRACY
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 CUMMINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2311
Mailing Address - Country:US
Mailing Address - Phone:423-821-1245
Mailing Address - Fax:423-821-1239
Practice Address - Street 1:3550 CUMMINGS HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2311
Practice Address - Country:US
Practice Address - Phone:423-821-1245
Practice Address - Fax:423-821-1239
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist