MEDICARE: MS. DIONNE MCCLAM

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	372600000X	Adult Companion
2	376J00000X	Homemaker
3	347C00000X	Private Vehicle	M245-163-82-520-0	FL

General Provider Information

NPI Number	:	1699463885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIONNE MCCLAM

Provider Business Mailing Address
First Line	:	PO BOX 5075
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32314-5075
Country	:	US
Telephone Number	:	850-212-4882
Fax Number	:

Provider Business Practice Location Address
First Line	:	7234 GARRETT RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-8069
Country	:	US
Telephone Number	:	850-212-4882
Fax Number	:

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

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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