Provider Demographics
NPI:1669677761
Name:MCLEAN, MAMIE ROBINSON
Entity Type:Individual
Prefix:
First Name:MAMIE
Middle Name:ROBINSON
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HWY 280
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:205-874-0000
Mailing Address - Fax:205-874-7021
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140989390200000X
AL30978390200000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117948OtherBCBS
MS06400328Medicaid
AL051117949OtherBCBS
AL129419Medicaid
AL129425Medicaid
AL129422Medicaid
AL129423Medicaid
AL051117950OtherBCBS
AL051117947OtherBCBS
AL129422Medicaid