MEDICARE: MISS STEPHANIE 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	3747P1801X	Personal Care Attendant		GA

General Provider Information

NPI Number	:	1578397329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE MCCLAIN

Provider Business Mailing Address
First Line	:	PO BOX 176
Second Line	:
City	:	PINE LAKE
State	:	GA
Zip	:	30072
Country	:	US
Telephone Number	:	404-721-2556
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 W TRINITY PL APT 3105
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3015
Country	:	US
Telephone Number	:	404-721-2556
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	04/10/2025

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