Provider Demographics
NPI:1417386087
Name:MCMAHON, JOHN KEVIN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 OLD CONCORD RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2043
Mailing Address - Country:US
Mailing Address - Phone:310-753-6516
Mailing Address - Fax:
Practice Address - Street 1:2816 OLD CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2043
Practice Address - Country:US
Practice Address - Phone:310-753-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst