Healthcare Provider Details

I. General information

NPI: 1144616459
Provider Name (Legal Business Name): JOHN RYAN MAHONEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TREE LN STE 300
SNELLVILLE GA
30078-6747
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE STE 1700
ATLANTA GA
30339-3087
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-4299
  • Fax: 678-214-6112
Mailing address:
  • Phone: 513-347-9999
  • Fax: 859-344-4153

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.014302
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number79435
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: