Provider Demographics
NPI:1558355263
Name:MCCLINTON, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:MCCLINTON
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 1:2301 NEWNAN CROSSING BLVD E STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2542
Mailing Address - Country:US
Mailing Address - Phone:770-683-2155
Mailing Address - Fax:770-683-2154
Practice Address - Street 1:2301 NEWNAN CROSSING BLVD E STE 120
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2542
Practice Address - Country:US
Practice Address - Phone:770-683-2155
Practice Address - Fax:770-683-2154
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068453207Y00000X
GA68453207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264617000Medicaid
TN4165410OtherBLUE CROSS BLUE SHIELD
TN3000787OtherMEDICARE PTAN
TN3000787Medicaid
FL2831191OtherAETNA
GA003127397AMedicaid
GA003127397BMedicaid
GA003127397BMedicaid
FLH69601Medicare UPIN