Provider Demographics
NPI:1053600973
Name:MCLEAN, GEORGIA (LMBT)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-1647
Mailing Address - Country:US
Mailing Address - Phone:828-964-3387
Mailing Address - Fax:
Practice Address - Street 1:2850 TYNECASTLE HWY
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-9716
Practice Address - Country:US
Practice Address - Phone:828-964-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist