Provider Demographics
NPI:1114655578
Name:MCMAHAN, PAUL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 LITTLE ROCK DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:MS
Mailing Address - Zip Code:39337-9329
Mailing Address - Country:US
Mailing Address - Phone:601-527-4811
Mailing Address - Fax:
Practice Address - Street 1:7466 LITTLE ROCK DECATUR RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:MS
Practice Address - Zip Code:39337-9329
Practice Address - Country:US
Practice Address - Phone:601-527-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer