Provider Demographics
NPI:1306468962
Name:MAHON, SAMANTHA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:MAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LEIGH
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 15TH ST # AF-1016
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0006
Mailing Address - Country:US
Mailing Address - Phone:706-721-4467
Mailing Address - Fax:706-721-9081
Practice Address - Street 1:1120 15TH ST # AF-1016
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0006
Practice Address - Country:US
Practice Address - Phone:706-721-4467
Practice Address - Fax:706-721-9081
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA12016207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program