Healthcare Provider Details

I. General information

NPI: 1356736417
Provider Name (Legal Business Name): BRETT MAGNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W BROAD ST STE 1
ATHENS GA
30601
US

IV. Provider business mailing address

855 W BROAD ST STE 1
ATHENS GA
30601-2511
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-6134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD182193
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: