Healthcare Provider Details

I. General information

NPI: 1861473969
Provider Name (Legal Business Name): EVERETT F MAGANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST SLOT# 783
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-7820
Mailing address:
  • Phone: 540-224-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE-6204
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number40241
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberE-6204
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: