Healthcare Provider Details

I. General information

NPI: 1164551503
Provider Name (Legal Business Name): MAGELLAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 NORTHWINDS PKWY
ALPHARETTA GA
30004-2241
US

IV. Provider business mailing address

2785 OAK MEADOW DR
SNELLVILLE GA
30078-2794
US

V. Phone/Fax

Practice location:
  • Phone: 800-201-8316
  • Fax:
Mailing address:
  • Phone: 770-736-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number002776
License Number StateGA

VIII. Authorized Official

Name: MR. NISHMA HERRERA-DAYA
Title or Position: SUPERVISOR
Credential: LMSW
Phone: 800-201-8316