Provider Demographics
NPI:1497357651
Name:MAHOME, KAMISHA
Entity Type:Individual
Prefix:
First Name:KAMISHA
Middle Name:
Last Name:MAHOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 CRANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1416
Mailing Address - Country:US
Mailing Address - Phone:678-740-2902
Mailing Address - Fax:
Practice Address - Street 1:4080 CRANWOOD DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1416
Practice Address - Country:US
Practice Address - Phone:678-740-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician