MEDICARE: DR. JULIA DAWN MAHANEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	300178	NY
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	300178	NY
3	2084P0800X	Psychiatry Physician	92674	SC

General Provider Information

NPI Number	:	1780656116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA DAWN MAHANEY D.O.

Provider Business Mailing Address
First Line	:	163 BALLYHOO ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-7406
Country	:	US
Telephone Number	:	210-845-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 N OAK ST STE 301F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3165
Country	:	US
Telephone Number	:	210-845-5529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	02/03/2026

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