Provider Demographics
NPI:1952852949
Name:MCMAHAN, AMBER LEE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 BROADRICK DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3011
Mailing Address - Country:US
Mailing Address - Phone:706-278-3431
Mailing Address - Fax:706-370-4859
Practice Address - Street 1:1506 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3011
Practice Address - Country:US
Practice Address - Phone:706-278-3431
Practice Address - Fax:706-370-4859
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000003363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care