MEDICARE: LILLIE MCLEAN APC, NCC

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	101Y00000X	Counselor	APC009946	GA

General Provider Information

NPI Number	:	1053279729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIE MCLEAN APC, NCC

Provider Business Mailing Address
First Line	:	4300 KINGSTON GATE CV
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1042
Country	:	US
Telephone Number	:	404-557-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1986 HOSEA L WILLIAMS DR NE STE C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-2225
Country	:	US
Telephone Number	:	706-406-3404
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	03/05/2026

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