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NPI Code Detail

MEDICARE: KAMISHA MAHOME

MEDICARE: KAMISHA MAHOME
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1497357651
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMISHA MAHOME
Provider Business Mailing Address
First Line : 4080 CRANWOOD DR
Second Line :
City : ATLANTA
State : GA
Zip : 30349-1416
Country : US
Telephone Number : 678-740-2902
Fax Number :
Provider Business Practice Location Address
First Line : 4080 CRANWOOD DR
Second Line :
City : ATLANTA
State : GA
Zip : 30349-1416
Country : US
Telephone Number : 678-740-2902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 11/12/2020

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Directions to “ KAMISHA MAHOME ” Practice Location

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