Healthcare Provider Details

I. General information

NPI: 1710856760
Provider Name (Legal Business Name): MAGGIE ZHU RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4366 LOG CABIN DR
MACON GA
31204-5604
US

IV. Provider business mailing address

4366 LOG CABIN DR
MACON GA
31204-5604
US

V. Phone/Fax

Practice location:
  • Phone: 478-471-6060
  • Fax: 478-476-8009
Mailing address:
  • Phone: 478-471-6060
  • Fax: 478-476-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH045701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: