Provider Demographics
NPI:1487389342
Name:MAHACHI, NELLIAH
Entity type:Individual
Prefix:MRS
First Name:NELLIAH
Middle Name:
Last Name:MAHACHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PENNBROOKE TRCE
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1879
Mailing Address - Country:US
Mailing Address - Phone:404-399-9842
Mailing Address - Fax:
Practice Address - Street 1:320 PENNBROOKE TRCE
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1879
Practice Address - Country:US
Practice Address - Phone:404-399-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily