1417398165 NPI number — DR. LAURA MINCH MCLAIN PSY, D.

Table of content: DR. LAURA MINCH MCLAIN PSY, D. (NPI 1417398165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417398165 NPI number — DR. LAURA MINCH MCLAIN PSY, D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLAIN
Provider First Name:
LAURA
Provider Middle Name:
MINCH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY, D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINCH
Provider Other First Name:
LAURA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417398165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 GLENLAKE PKWY
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-328-4100
Provider Business Mailing Address Fax Number:
770-671-8508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 GLENLAKE PKWY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-3486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-328-4100
Provider Business Practice Location Address Fax Number:
770-671-8508
Provider Enumeration Date:
07/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY003681 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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