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General NPI Number Information
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NPI Number | 1932223906
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Entity Type | Individual
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Provider Name | MR. SHAWN ROBERT MAHAN
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2925 BROWNS BRIDGE RD
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City | GAINESVILLE
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State | GA
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Zip | 30504-5505
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Country | US
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Telephone | 770-532-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 PROSPECT MILL DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-2694
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Country | US
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Telephone | 770-339-9194
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Fax | 678-377-9093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH019549
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License Number State | GA
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