Provider Demographics
NPI:1568770733
Name:MAHON, SAMANTHA HOLLY (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:HOLLY
Last Name:MAHON
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 KRISTINS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1811
Mailing Address - Country:US
Mailing Address - Phone:843-345-6597
Mailing Address - Fax:
Practice Address - Street 1:348 KRISTINS DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1811
Practice Address - Country:US
Practice Address - Phone:843-345-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic