Provider Demographics
NPI:1942895115
Name:MAHOU, SYDOINE (NURSE)
Entity Type:Individual
Prefix:
First Name:SYDOINE
Middle Name:
Last Name:MAHOU
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 REDDY FARM RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1754
Mailing Address - Country:US
Mailing Address - Phone:678-651-3140
Mailing Address - Fax:
Practice Address - Street 1:1115 MOUNT ZION RD STE J
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2266
Practice Address - Country:US
Practice Address - Phone:770-703-3549
Practice Address - Fax:531-200-7387
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN298645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse