Provider Demographics
NPI:1386907822
Name:MCMAHON, ERICA LEIGH (CST/CSFA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 BILL PRESLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-6014
Mailing Address - Country:US
Mailing Address - Phone:678-779-0475
Mailing Address - Fax:706-867-4186
Practice Address - Street 1:70 ANSLEY DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1613
Practice Address - Country:US
Practice Address - Phone:706-864-7904
Practice Address - Fax:706-867-4186
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA134116246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant