Provider Demographics
NPI:1841019262
Name:MCCLINTON, LAGINA M
Entity type:Individual
Prefix:
First Name:LAGINA
Middle Name:M
Last Name:MCCLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 MCCULLOUGH DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4393
Mailing Address - Country:US
Mailing Address - Phone:704-277-3538
Mailing Address - Fax:
Practice Address - Street 1:416 MCCULLOUGH DR STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4393
Practice Address - Country:US
Practice Address - Phone:704-277-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDURXVEEXHM171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor