Provider Demographics
NPI:1518176262
Name:MCCLURE, JAMIE M (NP)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:M
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2219
Mailing Address - Country:US
Mailing Address - Phone:770-597-6899
Mailing Address - Fax:
Practice Address - Street 1:120 GREYSTONE POWER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-8297
Practice Address - Country:US
Practice Address - Phone:470-267-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL17862255A2300X
GARN240864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer