Provider Demographics
NPI:1528358280
Name:MCLEAN, CAMILLE PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:PATRICE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 NEW HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3358
Mailing Address - Country:US
Mailing Address - Phone:718-614-8573
Mailing Address - Fax:
Practice Address - Street 1:2347 NEW HAVEN PL
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3358
Practice Address - Country:US
Practice Address - Phone:718-614-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine