Healthcare Provider Details

I. General information

NPI: 1003346248
Provider Name (Legal Business Name): ANUSHKA MAGAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 350
MARIETTA GA
30068-4396
US

IV. Provider business mailing address

5780 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1513
US

V. Phone/Fax

Practice location:
  • Phone: 770-509-8858
  • Fax:
Mailing address:
  • Phone: 404-303-8035
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number88005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: