Provider Demographics
NPI:1013279801
Name:MCGAHEE, MICHAEL KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEITH
Last Name:MCGAHEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 MATTOX CREEK DR
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-7636
Mailing Address - Country:US
Mailing Address - Phone:706-595-9518
Mailing Address - Fax:
Practice Address - Street 1:1971 MATTOX CREEK DR
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7636
Practice Address - Country:US
Practice Address - Phone:706-595-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURPH016142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist