Healthcare Provider Details

I. General information

NPI: 1891853420
Provider Name (Legal Business Name): WILLIAM LEWIS MCMAHON MD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 WINDING ROSE DR
SUWANEE GA
30024-3074
US

IV. Provider business mailing address

4905 WINDING ROSE DR
SUWANEE GA
30024-3074
US

V. Phone/Fax

Practice location:
  • Phone: 770-313-2034
  • Fax:
Mailing address:
  • Phone: 678-889-4880
  • Fax: 678-889-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: