Individual
MARY LAUREN MCCAULEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 S ENOTA DR NE STE 380, GAINESVILLE, GA 30501-3475
(770) 219-7099
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11140
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11140
GEORGIA MEDICAL COMPOSITE BOARD
GA
01
—
1169725
NCCPA ID
—
Enumeration date
01/09/2020
Last updated
02/15/2024
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