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General NPI Number Information
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NPI Number | 1053440610
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Entity Type | Organization
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Legal Business Name | MAHAN MEDICAL
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1705 MAHAN DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5201
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Country | US
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Telephone | 850-877-7164
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Fax | 850-656-1391
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Provider Business Mailing Address
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Address Line | 1705 MAHAN DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5201
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Country | US
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Telephone | 850-877-7164
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Fax | 850-656-1391
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Authorized Official
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Title or Position | VP
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Name | MICKEY PICKLER
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Credential |
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Telephone | 800-661-3365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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