MEDICARE: JIA MCCLAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH031893	GA

General Provider Information

NPI Number	:	1033886171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIA MCCLAIN

Provider Business Mailing Address
First Line	:	3730 CARMIA DR SW STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-6259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 CARMIA DR SW STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-6259
Country	:	US
Telephone Number	:	404-346-9253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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