Provider Demographics
NPI:1619969169
Name:MAHON, THOMAS M JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:MAHON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1786 OAK RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2234
Mailing Address - Country:US
Mailing Address - Phone:770-979-3456
Mailing Address - Fax:770-979-7476
Practice Address - Street 1:1786 OAK RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2234
Practice Address - Country:US
Practice Address - Phone:770-979-3456
Practice Address - Fax:770-979-7476
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA740334621AMedicaid
GA2200336OtherUNITED HEALTHCARE
GA52636582OtherBC&BS
GAU97573Medicare UPIN
GA52636582OtherBC&BS