Provider Demographics
NPI:1720118763
Name:MCCLANAHAN, DARBYE SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:DARBYE
Middle Name:SUZANNE
Last Name:MCCLANAHAN
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 1:1801 PEACHTREE ST NE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1881
Mailing Address - Country:US
Mailing Address - Phone:404-872-8837
Mailing Address - Fax:678-244-2155
Practice Address - Street 1:1801 PEACHTREE ST NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1881
Practice Address - Country:US
Practice Address - Phone:404-872-8837
Practice Address - Fax:678-244-2155
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32401207LP2900X, 207L00000X
GA062397207LP2900X
FLME 105956207L00000X
VA0101248737207L00000X
NY233219207L00000X
GA623972081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127579AMedicaid
NY02639045Medicaid
GA003127579BMedicaid
GA003127579CMedicaid
NYRA8454Medicare ID - Type Unspecified
NY02639045Medicaid
NYI32980Medicare UPIN