Provider Demographics
NPI:1427156900
Name:MCMAHON, MICHELE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 PARKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-466-7188
Mailing Address - Fax:912-466-7513
Practice Address - Street 1:2415 PARKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4722
Practice Address - Country:US
Practice Address - Phone:912-466-7188
Practice Address - Fax:912-466-7513
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041264207R00000X
GA64679208M00000X
GA064679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64679OtherGA LICENSE
CT110008905Medicare ID - Type Unspecified
GA64679OtherGA LICENSE