Provider Demographics
NPI:1730184359
Name:MCCLAIN, GARY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:MCCLAIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2060 DAN PROCTOR DR
Mailing Address - Street 2:STE 1400
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3894
Mailing Address - Country:US
Mailing Address - Phone:912-576-6355
Mailing Address - Fax:912-729-4654
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:STE 1400
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3894
Practice Address - Country:US
Practice Address - Phone:912-576-6355
Practice Address - Fax:912-466-6393
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2015-11-23
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Provider Licenses
StateLicense IDTaxonomies
GA62569207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD57149Medicare UPIN