Provider Demographics
NPI:1750143699
Name:MACLACHLAN, JOHN T (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:MACLACHLAN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 FOREST BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8114
Mailing Address - Country:US
Mailing Address - Phone:125-657-7216
Mailing Address - Fax:
Practice Address - Street 1:81 NORTHSIDE DAWSON DR STE 100
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-7164
Practice Address - Country:US
Practice Address - Phone:706-216-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner