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General NPI Number Information
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NPI Number | 1801838867
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Entity Type | Individual
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Provider Name | MATTHEW B MCCLAIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 255 W 5TH ST SW SUITE 150
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City | ROME
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State | GA
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Zip | 30165-2817
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Country | US
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Telephone | 706-232-1545
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Fax | 706-232-3819
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | ROME
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State | GA
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Zip | 30162-0369
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Country | US
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Telephone | 706-291-2077
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Fax | 706-235-4177
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 053274
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License Number State | GA
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