Individual
MRS. TRACIE L MCMAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1929 SPILLWAY RD STE A, BRANDON, MS 39047-6079
(601) 992-5370
(601) 992-5370
Mailing address
626 ROCK BRANCH ROAD, UNION, MS 39365
(601) 774-0565
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2959
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02781030
—
MS
Enumeration date
04/27/2007
Last updated
07/09/2007
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