Healthcare Provider Details

I. General information

NPI: 1912945346
Provider Name (Legal Business Name): KEVIN O MAHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

2835 BRANDY WINE RD 300
ATLANTA GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2593
  • Fax: 678-547-1494
Mailing address:
  • Phone: 770-488-9202
  • Fax: 678-547-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number055162
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: