Provider Demographics
NPI:1497743777
Name:MCLEAN, RONALD CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CRAIG
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 MARGIE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7887
Mailing Address - Country:US
Mailing Address - Phone:478-302-5106
Mailing Address - Fax:877-355-2288
Practice Address - Street 1:235 MARGIE DR STE 300
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7887
Practice Address - Country:US
Practice Address - Phone:478-302-5106
Practice Address - Fax:877-355-2288
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000365142WMedicaid
GA000365142YMedicaid
GA000365142XMedicaid
GABM1035915OtherDEA
GA000365142XMedicaid