Provider Demographics
NPI:1124059886
Name:MCMAHAN SHOES, INC.
Entity type:Organization
Organization Name:MCMAHAN SHOES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:404-634-9500
Mailing Address - Street 1:2122 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5367
Mailing Address - Country:US
Mailing Address - Phone:404-634-9500
Mailing Address - Fax:404-634-9555
Practice Address - Street 1:2122 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5367
Practice Address - Country:US
Practice Address - Phone:404-634-9500
Practice Address - Fax:404-634-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0682630001Medicare NSC