Healthcare Provider Details

I. General information

NPI: 1780656116
Provider Name (Legal Business Name): JULIA DAWN MAHANEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 16TH AVE N STE G
MYRTLE BEACH SC
29577-3537
US

IV. Provider business mailing address

608 16TH AVE N STE G
MYRTLE BEACH SC
29577-3537
US

V. Phone/Fax

Practice location:
  • Phone: 210-845-5529
  • Fax: 480-546-3211
Mailing address:
  • Phone: 210-845-5529
  • Fax: 480-546-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number300178
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number300178
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number92674
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: