Provider Demographics
NPI:1265091847
Name:MCCLINTON ENT OF NEWNAN, LLC
Entity type:Organization
Organization Name:MCCLINTON ENT OF NEWNAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-683-2155
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty