Provider Demographics
NPI:1457473779
Name:MCMAHAN, HOWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:C
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CARGILE RD
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-3606
Mailing Address - Country:US
Mailing Address - Phone:229-468-9903
Mailing Address - Fax:
Practice Address - Street 1:361 CARGILE RD
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-3606
Practice Address - Country:US
Practice Address - Phone:229-468-9903
Practice Address - Fax:229-468-5417
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL909920400Medicaid
GA00238587DMedicaid
581563893OtherTIN
GAD40623Medicare UPIN
FL909920400Medicaid