Provider Demographics
NPI:1669475695
Name:MCMAHAN, LYNN BRYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:BRYCE
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3107
Mailing Address - Country:US
Mailing Address - Phone:601-264-3937
Mailing Address - Fax:601-264-5930
Practice Address - Street 1:1420 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3107
Practice Address - Country:US
Practice Address - Phone:601-264-3937
Practice Address - Fax:601-264-5930
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06437207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115828Medicaid
MS512I180020OtherMEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS512I180021OtherMEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS512I180020OtherMEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS180000129Medicare ID - Type Unspecified