Provider Demographics
NPI:1932118502
Name:MCMAHON, ALISA (AUD)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4883
Mailing Address - Country:US
Mailing Address - Phone:864-281-9440
Mailing Address - Fax:
Practice Address - Street 1:879 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2055
Practice Address - Country:US
Practice Address - Phone:864-281-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2450231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ32461Medicare UPIN