Healthcare Provider Details

I. General information

NPI: 1043036585
Provider Name (Legal Business Name): DEMETRIC D MAGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 OAK ST
BILOXI MS
39530-4517
US

IV. Provider business mailing address

7288 FRANCIS DR
GAUTIER MS
39553-2869
US

V. Phone/Fax

Practice location:
  • Phone: 228-215-1672
  • Fax: 228-233-3172
Mailing address:
  • Phone: 228-215-1672
  • Fax: 228-233-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: