Provider Demographics
NPI:1467569624
Name:MCMAHAN, ALAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:P
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 1:202 PERRY HWY
Mailing Address - Street 2:STE 104
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6748
Mailing Address - Country:US
Mailing Address - Phone:478-783-4924
Mailing Address - Fax:478-783-4905
Practice Address - Street 1:1085 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9102
Practice Address - Country:US
Practice Address - Phone:478-559-1098
Practice Address - Fax:478-783-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034017174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457223IMedicaid
GAE74499Medicare UPIN
GA000457223IMedicaid