1013365550 NPI number — MRS. MARGARET FITCH MCCLELLAN AGPCNP, MSN, RN

Table of content: MRS. MARGARET FITCH MCCLELLAN AGPCNP, MSN, RN (NPI 1013365550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013365550 NPI number — MRS. MARGARET FITCH MCCLELLAN AGPCNP, MSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLELLAN
Provider First Name:
MARGARET
Provider Middle Name:
FITCH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP, MSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013365550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15238
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31416-1938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-354-4813
Provider Business Mailing Address Fax Number:
912-354-7569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5353 REYNOLDS ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-6089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-819-5750
Provider Business Practice Location Address Fax Number:
912-819-5752
Provider Enumeration Date:
05/25/2016

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: 363LG0600X , with the licence number:  RN222787 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: RN222787 , 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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