Provider Demographics
NPI:1801838867
Name:MCCLAIN, MATTHEW B (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0369
Mailing Address - Country:US
Mailing Address - Phone:706-291-2077
Mailing Address - Fax:706-235-4177
Practice Address - Street 1:255 W 5TH ST SW
Practice Address - Street 2:SUITE 150
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2817
Practice Address - Country:US
Practice Address - Phone:706-232-1545
Practice Address - Fax:706-232-3819
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0532742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA166986931AMedicaid
GA923349OtherBCBS OF GEORGIA
GA923349OtherBCBS OF GEORGIA
GA166986931AMedicaid