Healthcare Provider Details

I. General information

NPI: 1629153937
Provider Name (Legal Business Name): NANCY GAIL MCLAURIN DMD PC DMD PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD NE SUITE G-73
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD NE SUITE G-73
ATLANTA GA
30342-1703
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-9511
  • Fax: 404-256-0901
Mailing address:
  • Phone: 404-255-9511
  • Fax: 404-256-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number011011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: