Healthcare Provider Details

I. General information

NPI: 1841995941
Provider Name (Legal Business Name): CYNTHIA L MAGWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 HAWKINSVILLE RD
MACON GA
31216-5848
US

IV. Provider business mailing address

6132 HAWKINSVILLE RD
MACON GA
31216-5848
US

V. Phone/Fax

Practice location:
  • Phone: 478-788-0066
  • Fax:
Mailing address:
  • Phone: 478-788-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPN062672
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN062672
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: