Healthcare Provider Details

I. General information

NPI: 1023912466
Provider Name (Legal Business Name): MARY CLAYTON MCLANE GABY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CLAYTON MCLANE RN

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 AVENUE PL
ATLANTA GA
30329-4015
US

IV. Provider business mailing address

1520 AVENUE PL
ATLANTA GA
30329-4015
US

V. Phone/Fax

Practice location:
  • Phone: 404-639-5575
  • Fax:
Mailing address:
  • Phone: 404-639-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP303273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: