Healthcare Provider Details

I. General information

NPI: 1215856596
Provider Name (Legal Business Name): VERONICA MCCLANAHAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PILGRIM VILLAGE DR STE 300
CUMMING GA
30040-9232
US

IV. Provider business mailing address

3050 WHITFIELD AVE
CUMMING GA
30040-6350
US

V. Phone/Fax

Practice location:
  • Phone: 678-595-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: