Provider Demographics
NPI:1730872334
Name:MCMAHON, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCMAHON
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 1:357 SPENCER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-1530
Mailing Address - Country:US
Mailing Address - Phone:205-434-5681
Mailing Address - Fax:
Practice Address - Street 1:357 SPENCER LAKES DR
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-1530
Practice Address - Country:US
Practice Address - Phone:205-434-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered