Healthcare Provider Details

I. General information

NPI: 1972494375
Provider Name (Legal Business Name): MARY ELIZABETH MCCLAIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 ROSWELL RD STE 140
MARIETTA GA
30062-4719
US

IV. Provider business mailing address

6018 SANDY SPRINGS CIR
ATLANTA GA
30328-3832
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-0011
  • Fax:
Mailing address:
  • Phone: 404-256-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAA000271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: