Provider Demographics
NPI:1821582230
Name:MCMAHAN, CAROLLYNN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLLYNN
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 BRITTON DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-8620
Mailing Address - Country:US
Mailing Address - Phone:770-366-9926
Mailing Address - Fax:
Practice Address - Street 1:5058 BRITTON DR
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-8620
Practice Address - Country:US
Practice Address - Phone:770-366-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist