Healthcare Provider Details

I. General information

NPI: 1114632643
Provider Name (Legal Business Name): STEPHANIE COOK MCLAIN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N CUTHBERT ST
COLQUITT GA
39837-3517
US

IV. Provider business mailing address

209 N CUTHBERT ST
COLQUITT GA
39837-3518
US

V. Phone/Fax

Practice location:
  • Phone: 229-281-6096
  • Fax: 229-281-6097
Mailing address:
  • Phone: 229-758-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN230610
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: