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General NPI Number Information
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NPI Number | 1417961152
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Entity Type | Organization
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Legal Business Name | MICHAEL J MAHAFFEY, D.M.D, P.C.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8 EASTBROOK BND SUITE B
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1530
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Country | US
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Telephone | 770-487-6439
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Fax | 770-487-7539
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Provider Business Mailing Address
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Address Line | 8 EASTBROOK BND SUITE B
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1530
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Country | US
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Telephone | 770-487-6439
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Fax | 770-487-7539
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Authorized Official
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Title or Position | DOCTOR
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Name | MICHAEL JACK MAHAFFEY
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Credential | D.M.D., M.S.
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Telephone | 770-487-6439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12464
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License Number State | GA
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