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NPI Code Detail

MEDICARE: DR. MAGDY W REZK M.D.

MEDICARE: DR. MAGDY W REZK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician053936GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1249270OTHERGABLUE CROSS/BLUE SHIELD #
2053936OTHERGAGEORGIA MEDICAL LICENSE #

General Provider Information

NPI Number : 1053318808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAGDY W REZK M.D.
Provider Business Mailing Address
First Line : 3203 S CHEROKEE LN. STE 220
Second Line : WEATHERSTONE MEDICAL CARE LLC.
City : WOODSTOCK
State : GA
Zip : 30188
Country : US
Telephone Number : 770-675-6025
Fax Number : 770-675-7814
Provider Business Practice Location Address
First Line : 3203 S CHEROKEE LN.
Second Line : STE 220 WEATHERSTONE MEDICAL CARE LLC.
City : WOODSTOCK
State : GA
Zip : 30188-4461
Country : US
Telephone Number : 770-675-6025
Fax Number : 770-675-7814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 03/07/2023

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