Provider Demographics
NPI:1366865719
Name:MCLAULIN PRACTICE LLC
Entity Type:Organization
Organization Name:MCLAULIN PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:MCLAULIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:215-284-8434
Mailing Address - Street 1:283 MILTON LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-1931
Mailing Address - Country:US
Mailing Address - Phone:215-284-8434
Mailing Address - Fax:
Practice Address - Street 1:283 MILTON LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:GA
Practice Address - Zip Code:31565-1931
Practice Address - Country:US
Practice Address - Phone:215-284-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022248261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health