=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497877468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY MCMAHAN CHRISTENBURY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2160 FOUNTAIN DR STE 100
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-7022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-990-1880
-----------------------------------------------------
Fax | 678-990-1884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2160 FOUNTAIN DR STE 100
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-7022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-990-1880
-----------------------------------------------------
Fax | 678-990-1884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 88622
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 27437
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------