MEDICARE: HARRISON S MAHON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME151513	FL
2	207X00000X	Orthopaedic Surgery Physician	ME151513	FL

General Provider Information

NPI Number	:	1477943579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRISON S MAHON MD

Provider Business Mailing Address
First Line	:	PO BOX 746647
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6647
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY DR STE 200
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8505
Country	:	US
Telephone Number	:	904-161-9503
Fax Number	:	904-376-3062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	01/22/2025

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Directions to “ HARRISON S MAHON MD” Practice Location

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