Healthcare Provider Details

I. General information

NPI: 1225900525
Provider Name (Legal Business Name): MCMAHON WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MORROW RD APT 27E
FOREST PARK GA
30297-2824
US

IV. Provider business mailing address

228 MORROW RD APT 27E
FOREST PARK GA
30297-2824
US

V. Phone/Fax

Practice location:
  • Phone: 770-430-9897
  • Fax:
Mailing address:
  • Phone: 770-430-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEYLA MCMAHON
Title or Position: OWNER
Credential: CNA
Phone: 770-430-9897