Healthcare Provider Details

I. General information

NPI: 1770839607
Provider Name (Legal Business Name): SANDRA L. MAGER, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W. CHERRY STREET
JESUP GA
31545
US

IV. Provider business mailing address

114 W. CHERRY STREET
JESUP GA
31545
US

V. Phone/Fax

Practice location:
  • Phone: 912-588-1020
  • Fax: 912-588-1002
Mailing address:
  • Phone: 912-588-1020
  • Fax: 912-588-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38043
License Number StateGA

VIII. Authorized Official

Name: SANDRA MAGER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 912-588-1020