Provider Demographics
NPI:1164042677
Name:MCMAHAN, ALIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HAMMOCKVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411
Mailing Address - Country:US
Mailing Address - Phone:912-202-0405
Mailing Address - Fax:
Practice Address - Street 1:6 HOLMES CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4800
Practice Address - Country:US
Practice Address - Phone:912-254-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
GA9795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant