MEDICARE: TAMMY K. MCLEAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	053496	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01338529	OTHER	GA	RAILROAD MEDICARE
3	202I071208	OTHER	GA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457365686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY K. MCLEAN MD

Provider Business Mailing Address
First Line	:	6600 WHITTLESEY BLVD UNIT A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7334
Country	:	US
Telephone Number	:	706-323-3491
Fax Number	:	706-660-9191

Provider Business Practice Location Address
First Line	:	6600 WHITTLESEY BLVD UNIT A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7334
Country	:	US
Telephone Number	:	706-323-3491
Fax Number	:	706-660-9191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/06/2017

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Directions to “ TAMMY K. MCLEAN MD” Practice Location

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