Healthcare Provider Details

I. General information

NPI: 1811276116
Provider Name (Legal Business Name): NANCY KATHERINE MCLAURIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 WALNUT ST STE 200
MACON GA
31201-2677
US

IV. Provider business mailing address

2490 RIVERSIDE DR SUITE B
MACON GA
31204-1750
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-7566
  • Fax:
Mailing address:
  • Phone: 478-633-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN117468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: