MEDICARE: CAMILLE PATRICE MCLEAN M.D.

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	207R00000X	Internal Medicine Physician	2015-00102	NC

General Provider Information

NPI Number	:	1528358280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE PATRICE MCLEAN M.D.

Provider Business Mailing Address
First Line	:	2347 NEW HAVEN PL
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-3358
Country	:	US
Telephone Number	:	718-614-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2347 NEW HAVEN PL
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-3358
Country	:	US
Telephone Number	:	718-614-8573
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/09/2015

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