Healthcare Provider Details

I. General information

NPI: 1194349563
Provider Name (Legal Business Name): MAJA MAGAZIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD STE 400
MEMPHIS TN
38119-0845
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6650
  • Fax: 901-302-2486
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11873
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5549
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: