Provider Demographics
NPI:1629318035
Name:MAHON FAMILY MEDICINE
Entity Type:Organization
Organization Name:MAHON FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:770-925-2526
Mailing Address - Street 1:1786 OAK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2220
Mailing Address - Country:US
Mailing Address - Phone:770-925-2526
Mailing Address - Fax:
Practice Address - Street 1:1786 OAK RD
Practice Address - Street 2:SUITE B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2220
Practice Address - Country:US
Practice Address - Phone:770-925-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2024-02-14
Deactivation Date:2022-09-19
Deactivation Code:
Reactivation Date:2022-11-28
Provider Licenses
StateLicense IDTaxonomies
GA43693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty