Provider Demographics
NPI:1750018420
Name:MCCLARY, QUMANE
Entity type:Individual
Prefix:
First Name:QUMANE
Middle Name:
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CARDEN PLACE DR
Mailing Address - Street 2:APT H
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302
Mailing Address - Country:US
Mailing Address - Phone:919-448-5634
Mailing Address - Fax:
Practice Address - Street 1:149 CARDEN PLACE DR
Practice Address - Street 2:APT H
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302
Practice Address - Country:US
Practice Address - Phone:919-448-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver