Provider Demographics
NPI:1821639154
Name:MCMAHAN, GRACE BLANE (PA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:BLANE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 MONTCLAIR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1203
Mailing Address - Country:US
Mailing Address - Phone:205-592-4880
Mailing Address - Fax:
Practice Address - Street 1:1419 HAMRIC DR E STE 101
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2174
Practice Address - Country:US
Practice Address - Phone:256-235-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE