Healthcare Provider Details

I. General information

NPI: 1083906960
Provider Name (Legal Business Name): GEORGE ALLEN MAYHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365A CLIFTON RD NE SUITE AT-627
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3800
  • Fax:
Mailing address:
  • Phone: 404-778-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number305106
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: