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General NPI Number Information
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NPI Number | 1568650489
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Entity Type | Organization
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Legal Business Name | HENRY A MAGNANT MD PC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 911 DULUTH HWY STE D7
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5320
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Country | US
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Telephone | 770-995-0226
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Fax | 770-995-0227
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Provider Business Mailing Address
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Address Line | 911 DULUTH HWY STE D7
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | LINA DIAZ
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Credential |
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Telephone | 770-995-0226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | GA19072
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License Number State | GA
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