Healthcare Provider Details

I. General information

NPI: 1235911249
Provider Name (Legal Business Name): MAKAYLA L MCLAURIN TRANSPORTATION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 NORTH AVE
JONESBORO GA
30236-3215
US

IV. Provider business mailing address

111 ASHAND GROVE
STOCKBRIDGE GA
30281-3215
US

V. Phone/Fax

Practice location:
  • Phone: 470-654-9958
  • Fax: 770-522-6179
Mailing address:
  • Phone: 678-697-9070
  • Fax: 770-522-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number20033633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: