Healthcare Provider Details

I. General information

NPI: 1366976987
Provider Name (Legal Business Name): CALEB MAGISTRO AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 CHESHIRE BRIDGE RD NE UNIT A
ATLANTA GA
30324-4234
US

IV. Provider business mailing address

1700 BRIARCLIFF RD NE
ATLANTA GA
30306-2106
US

V. Phone/Fax

Practice location:
  • Phone: 404-273-2807
  • Fax:
Mailing address:
  • Phone: 404-273-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG0616142
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN210284
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: