MEDICARE: DR. MAGALIE NELSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	067777	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083720411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGALIE NELSON M.D.

Provider Business Mailing Address
First Line	:	5025 BARRINGTON DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-8991
Country	:	US
Telephone Number	:	229-435-7161
Fax Number	:	229-438-8588

Provider Business Practice Location Address
First Line	:	605 POINTE NORTH BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-1514
Country	:	US
Telephone Number	:	229-435-7161
Fax Number	:	229-438-8588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	06/24/2014

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