James Roger Mahon, M.D.
Individual provider Active NPI Family Medicine Physician · Fountain Inn, SC
NPI 1689769424 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689769424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 8010 (SC)
- Practice address
- 300 S Main St
Fountain Inn Family Practice
Fountain Inn, SC 29644-1931 - Phone
- (864) 862-3471
- Fax
- (864) 862-2444
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8010 | SC | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8010 | SC | Yes |
Addresses
Primary practice location
300 S Main St
Fountain Inn Family Practice
Fountain Inn, SC 29644-1931
Mailing address
300 S Main St
Fountain Inn Family Practice
Fountain Inn, SC 29644-1931
Phone (864) 862-3471
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080101 | Medicaid | SC |
Other providers in Fountain Inn, SC
- Legacy Women'S Health and Wellness
- Oral Lewis
- Lillian R Lopez
- Kathleen Elizabeth Loring
- Lyfe Intervention Services
- Majestic Home Health Care LLC
- Payton Malone
- Mama T Herbs LLC
- Randy L Marg
- Katlyn Marks
All providers in Fountain Inn, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.