Provider Demographics
NPI:1578788410
Name:HOWARD C MCMAHAN MD IRWIN FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:HOWARD C MCMAHAN MD IRWIN FAMILY MEDICINE ASSOCIATES
Other - Org Name:IRWIN COUNTY FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-468-9903
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774
Mailing Address - Country:US
Mailing Address - Phone:229-468-9903
Mailing Address - Fax:229-468-5417
Practice Address - Street 1:361 CARGILE ROAD
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774
Practice Address - Country:US
Practice Address - Phone:229-468-9903
Practice Address - Fax:229-468-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00238587DMedicaid
=========OtherTIN
=========OtherTIN
GAGRP5041Medicare PIN